Deceased donors are labeled increased infectious risk (IRD) if they meet certain criteria; however, stigma, legal and regulatory burden to centers, and decreased organ utilization may result from overuse of this label. New PHS guidelines for determining IRD status were implemented in 2014; these included additional criteria such as having a sexually transmitted infection. We aimed to 1) quantify the impact of the new guidelines on percent of donors labeled IRD and IRD discard rate, and 2) characterize change in the demographic and clinical characteristics of IRDs.

Methods: Among 80,007 deceased donors captured in SRTR, we used Poisson regression with interaction terms to quantify any increases above what would be expected based on existing trends in the percent of donors labeled IRD under the new guidelines. Modified poisson regression was used to calculate relative rate of discard adjusting for donor characteristics.

Results: Under the new guidelines, 19.5% donors were labeled IRD, compared to 12.3% 1 year earlier under the old guidelines (Figure 1), and this increase was statistically significant (p<0.001) Under the new guidelines, 9 OPOs labeled >25% of their donors IRD, compared to only 1 under the old (Figure 2). African-Americans were 52% more likely to be labeled IRD under the new guidelines (RR interaction = 1.52, p = 0.01). IRDs were 43% more likely to be discarded under the new guidelines.

Conclusion: There has been a significant increase in donors labeled IRD under the new PHS guidelines; overuse of this label may place undue burden on centers and OPOs, worsen existing racial disparities, and ultimately decrease organ utilization.

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