*Purpose: The continued shortage of organs for the over 100,000 candidates on the waitlist has led transplant centers to consider organs that have historically higher discard rates due to associated risk, most notably PHS (Public Health Service) high risk organs. According to OPTN data, in 2018 PHS organs made up 27% of all deceased donors but also had a discard rate of 40%. PHS published guidelines in 2013 to categorize donors who based on certain defined high-risk behaviors may place a recipient at an increased risk of exposure to Hepatitis C (HCV), Hepatitis B (HBV), and Human Immunodeficiency Virus (HIV). Aim: As a large multi-organ transplant center, we sought to investigate the actual transmission rate in our recipients who received a PHS organ.

*Methods: Transplant recipients who were transplanted with a PHS organ between 1/2015- 12/2018 were included in the sample, exclusions included patients who died prior to completing PHS testing. The sample consisted of a total of 368 PHS organs, including: 99 hearts, 141 kidneys, 2 kidney-pancreas, 98 livers, and 28 lungs. All recipient’s charts were reviewed post-transplant to confirm results of HIV, HCV, and HBV testing.

*Results: Out of the 368 PHS organs transplanted, only two organs developed HCV post-transplant despite having a negative HCV Nucleic Acid Test (NAT) test recorded in Donornet.(See Table 1) Of note the recipient received both the kidney and liver from the same donor.

*Conclusions: PHS classification was deemed necessary to ensure recipients were aware of the possible increased risk of developing HIV, HCV, and HBV post-transplant if they accepted a PHS organ. This labeling of some organs as PHS has caused an inflated risk perception in both providers and patients, which contributes to high discard rates. OPTN developed policy in 2015 that requires all organs to be NAT tested for HIV, HBV and HCV at time of organ offer; and according to the Disease Transmission and Advisory Committee publication in 2017, a NAT negative organ decreases transmission risk to less than 1%. This inclusion of NAT testing raises the question: Is PHS still a necessary classification or should every organ be consented as having a standard risk of possible transmission?

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