*Purpose: A previous review from one U.S. organ procurement organization (OPO) concluded positive HCV test results yielded high rates of authorized/not recovered donors (ANR), low organs transplanted per donor (OTPD) and higher discard rates. The OPO wished to re-evaluate the impact and acceptance of HCV positive donors to see if these factors have changed over time.

*Methods: An analysis between two 15-month time frames of recovered organ donors and ANRs was performed and compared. Test results, organs recovered, and organs transplanted were analyzed.

*Results: The initial time frame was between 1/1/2016 and 3/31/2017 (213 donors; 105 ANRs). The recent data set was between 1/1/2018 and 3/31/2019 (226 donors; 89 ANRs). The recent data set contained 13 additional donors (+6.1%) and 16 fewer ANRs (-15.2%). There were almost equal cases that tested positive for one or both HCV results compared to the previous review (25 vs 26). Of the 25 cases, 17 (5.4% of all cases, 68% of HCV+ cases) compared to 10 previously (3.1% of all cases, 38.5% of HCV+ cases) were recovered donors and 8 (2.5% of all cases, 32.0% of HCV+ cases) compared to 16 (5.0% of all cases, 61.5% of HCV+) were ANRs. Recovered donors positive for HCV increased 70% (10, 17) which yielded 145% increase in organs recovered (20, 49) and a 300% increase in organs transplanted (8, 32) resulting in an increase of OTPD from 0.8 to 1.88. Also noteworthy is a decrease in organs discarded by 42.2%. Organs transplanted in the recent data set comprised of 15 kidneys, 8 livers, 3 hearts and 6 lungs compared to 4 livers and 4 kidneys. The recent data set included two additional HCV+ cases (9 vs 7) where the donors were anti-HCV+/HCV NAT-; of these, both data sets had 5 recovered donors although an increase of 44.4% organs recovered (13 vs 9) and 700% increase of organs transplanted (8 vs 1) and 1.6 vs. 0.2 OTPD. Also, there were 5 DCD donors in both data sets yielding a single organ transplanted (liver).

*Conclusions: The data suggests that a positive HCV result may no longer result in high rates of ANRs, low OTPD and high discard rates. This OPO also suggests that with changing U.S. acceptance practices, more HCV positive organs are being utilized, including thoracic organs transplanted, in the recent data set. Antibody positive, NAT negative results again indicate no better outcomes than donors positive for both tests. Further we conclude that minimal organs are transplanted from DCD donors positive for HCV. We suggest continued review in the acceptance of HCV positive donors as transplant practices change.

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