Use of Hepatitis C Positive Organs: Patient Attitudes in Urban Chicago

Abstract

Background: Hepatitis C virus (HCV)-infected organs are being transplanted in patients with and without HCV in the direct-acting antiviral era. Little is known about patient attitudes towards receiving an HCV-positive organ. Objectives: The aim of this study is to determine transplant candidates’ attitudes towards receiving HCV-positive organs. Methods: Adult solid organ transplant candidates were identified during a clinic visit or during outpatient hemodialysis from May to December 2017. Willing participants completed a survey. Descriptive analysis including mean and median for continuous variables and frequencies for categorical variables were calculated by the appropriate statistical method and compared across willing, unsure, and unwilling patients and between willing and unsure/unwilling patients. Results: Fifty patients were surveyed with median age 54.5 years (range 32–77). Eighty-eight percent were awaiting kidney transplant, and 12% were awaiting other organs. Median waitlist time was 39.8 months (range 1.7–203 months). Most patients (90%) had prior knowledge of HCV, but only 60% knew it was curable. Forty-six percent were willing, 30% were unsure, and 24% were unwilling to receive an HCV-positive organ. Those willing to accept an HCV-positive organ were significantly older, Caucasian, had shorter waitlist times, and had greater physician trust than those that were unsure/unwilling. Similar worries, such as HCV incurability, insurance coverage, fears over the organ not working, and post-transplant death, were expressed in both the willing and unsure/unwilling patients. Conclusions: The availability of HCV-positive organs may expand the donor pool and decrease waitlist times and mortality. These data highlight the need for patient education towards use of these organs.

Increasing Utilization and Excellent Initial Outcomes Following Liver Transplant of Hepatitis C Virus (HCV)‐Viremic Donors Into HCV‐Negative Recipients: Outcomes Following Liver Transplant of HCV‐Viremic Donors

“…In a study of 50 patients awaiting organ transplantation (86% for kidneys), only 60% knew that HCV was a curable disease and only 46% were willing to accept such an organ. Moreover, concerns over HCV curability, insurance coverage, and allograft failure were also expressed . This series, albeit small, underscores the need to expand the knowledge of the impact of the utilization of HCV‐viremic organs in non‐HCV‐viremic kidney recipients.…”

“…Moreover, concerns over HCV curability, insurance coverage, and allograft failure were also expressed. (28) This series, albeit small, underscores the need to expand the knowledge of the impact of the utilization of HCV-viremic organs in non-HCV-viremic kidney recipients. The same issue applies to those awaiting LT, and studies addressing access to treatment and cost of HCV treatment in this population are needed.…”

Patient Willingness to Accept Hepatitis C-Infected Kidneys for Transplantation.

“…However, in contrast to our ndings, these studies found that older patients and white patients were more willing to accept HCV-infected kidneys than younger and black patients, respectively. [13,14] The reason for the contrast in the results is unclear but may represent unmeasured differences in each transplant center's characteristics and patient population.…”

When Theory Becomes Reality: Navigating the Ethics of Transplanting Hepatitis C Virus–Positive Livers Into Negative Recipients

“…Given that HCV D + /R − LT is already occurring, ensuring its fairness nationwide and justice for patients in need of LT is paramount. LT providers need to ensure that providing HCV D + /R − LT does not disadvantage patients or communities who may have been misinformed or have outdated information about HCV pathology and treatment after LT. One recent patient survey study showed that African Americans were less likely than whites to accept an HCV + kidney graft . Although it is unclear whether this attitude extends to liver grafts, further studies are needed to determine whether disparities exist in beliefs toward HCV D + /R − LT.…”

“…LT providers need to ensure that providing HCV D + /R − LT does not disadvantage patients or communities who may have been misinformed or have outdated information about HCV pathology and treatment after LT. One recent patient survey study showed that African Americans were less likely than whites to accept an HCV + kidney graft. 27 Although it is unclear whether this attitude extends to liver grafts, further studies are needed to determine whether disparities exist in beliefs toward HCV D + /R − LT. Furthermore, to promote equity in liver graft allocation, transplant centers that do not provide HCV D + /R − LT should inform their patients that other transplant centers may be performing HCV D + /R − LT.…”