The Public Health Service (PHS) guidelines use behavioral risk factors to designate certain organ donors as carrying increased risk for the transmission of hepatitis B, C, and HIV despite negative testing. OPTN policy requires that potential recipients be notified of this “increased risk” designation, although the magnitude of risk for disease transmission is approximately 1 in 1,000. We aimed to determine the impact of this label on organ utilization using OPTN data. Among adult donors (someone from whom at least one organ was procured for the purpose of transplantation) during 2010-2013, utilization rates were lower among PHS+ donors than PHS- donors for every organ except for liver (see figure). For example, 4,073/5,314 (76.7%) PHS+ kidneys were used, compared with 25,490/30,456 (83.7%) PHS- kidneys – an absolute difference of 7%. Furthermore, all PHS+ organs had higher export rates than PHS- organs. For example, 28.7% of PHS+ kidneys were exported, versus 19.7% of PHS- kidneys. Finally, the utilization rate of PHS+ organs varied by Donation Service Area. Utilization ranged from 20% to 100% among adult kidneys, suggesting significant variation in practices. Similar patterns were seen among pediatric donors. In conclusion, the PHS “increased risk” label appears to be associated with non-utilization of hundreds of organs per year, despite the very low risk of disease transmission. Better tools are needed to communicate the magnitude of risk to patients and their families.

CITATION INFORMATION: Volk M, Wilk A, Wolfe C, Kaul D. The “PHS Increased Risk” Label Is Associated with Non-Utilization of Hundreds of Organs Per Year. Am J Transplant. 2016;16 (suppl 3).

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