*Purpose: There has been a marked increase in the utilization of organs from hepatitis C virus (HCV) viremic donors due to the rise of drug-related deaths, and the emerging success of pilot studies of this practice. Studies have shown that the largest number of donors and transplants from HCV-viremic donors have occurred at transplant centers in the Northeast, mid-Atlantic, and parts of the Ohio Valley and Southeast. Although this phenomenon has been noted, little is known about the epidemiological patterns underlying the geographic distribution of HCV-viremic donors.

*Methods: We examined OPTN/UNOS data on all adult deceased organ donors from 3/1/2015-6/30/2019. We classified donors based on their HCV nucleic acid test (NAT) status and intravenous drug use (IVDU) as coded in OPTN/UNOS data. Using R (version 3.4.4), we calculated Pearson correlation coefficients between the percentage of donors from a state that were HCV NAT positive and the percentage of deceased donors with IVDU.

*Results: During the study period, the highest percentage of HCV-viremic deceased donors was seen in the mid-Atlantic and New England and ranged from a low of 0% in North Dakota, Nebraska, and Wyoming to a high of 22.0% in donors from Vermont (Figure 1). A similar pattern of IVDU among deceased donors was seen, with the highest rates in the mid-Atlantic and New England, with 41.3% of adult deceased donors in Massachusetts having a history of IVDU (Figure 2). There was a strong correlation between the percentage of HCV-viremic donors from a state and the percentage of deceased donors with IVDU (Pearson correlation coefficient: 0.84; Figure 3).

*Conclusions: These data demonstrate that IVDU is a key risk factor for HCV viremia among deceased donors. The geographic differences in IVDU among deceased donors appears to explain the geographic differences in the prevalence of HCV-viremic donors.

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