*Purpose: Previously a single organ procurement organization (OPO) reviewed data from a 15 month cohort (1/1/2016 to 3/31/17) and concluded that donors who tested positive for HCV resulted in a high rate of authorized/not recovered (ANR) donors and had greater risk when recovered to yield low OTPD with high discard rates. This OPO sought to expand the study to include broader experience from around the country to evaluate if the results were similar.

*Methods: A 30-month review of recovered organ donors and ANRs was performed with data from seven different OPOs. Test results, organs recovered, and organs transplanted were analyzed for each donor and ANR.

*Results: Between 1/1/2015 and 6/30/2017, there were 3040 donors recovered and 950 ANRs. 389 cases (9.7%) tested positive for one or both HCV tests. 244 (6.1% of all cases, 62.7% of HCV+ cases) were recovered donors; 145 (3.6% of all cases, 37.3% of HCV+ cases) were ANRs. The 244 recovered cases resulted in 558 organs recovered and 398 organs (185 kidneys, 190 livers, 13 hearts, 10 lungs) transplanted for OTPD of 1.6 and a discard rate of 28.7% vs the limited single OPO experience of 0.8 OTPD and a discard rate of 60%. 120 HCV+ cases were anti-HCV +/HCV NAT -; of these 87 were recovered (72.5% of cases with discordant results) yielding 195 recovered organs and 128 organs (51 kidneys, 63 livers, 8 hearts, 6 lungs) transplanted for OTPD of 1.5 and a discard rate of 34.4%. Of note there were 255 cases in which both anti-HCV and HCV-NAT were reactive; 147 were recovered cases (57.6% of both HCV+) yielding 339 recovered organs and 250 (123 kidneys, 120 livers, 5 hearts, 2 lungs) transplanted organs for an OTPD of 1.7 and a discard rate of 26.3%. There were also 9 anti-HCV -/HCV NAT+ cases yielding 13 recovered organs and 11 organs (6 kidneys, 5 livers) transplanted (OTPD=1.2) with a 15.4% discard rate. Finally, 52 DCD cases tested positive for one or both HCV tests; 28 were recovered donors with 33 organs (27 kidneys, 6 livers) transplanted (OTPD=1.2).

*Conclusions: On broader review more organs are transplanted from HCV positive donors compared to the single OPO experience. This may result partially from regional variance as well as a larger cohort and greater review period. Both HCV positive DCD recovered donors and HCV positive thoracic organs transplanted suggest that there may be more potential than observed on individual OPO review. Further we confirmed that negative HCV NAT compared to both antibody and HCV NAT positives does not appear to provide benefit in organ placement.

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