Impact of the OPTN transmissible diseases policy and US PHS increased risk donor guidelines on living donor candidates

Rebecca Hays, Elisa J. Gordon, Michael G. Ison, Dianne LaPointe Rudow*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Donor-derived human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV) transmissions in transplantation have led to policies mandating assessment of donor behavioral history, and disclosure of donor increased risk (IR) status to recipients. Organ Procurement Transplantation Network (OPTN) policy safeguards were promulgated in the context of deceased donation, with its narrow time window for organ utilization and uncertainty about donor history. These policies have been applied to living donation without substantive data on risk of disease transmission in living donor transplantation. Unlike for deceased donors, the OPTN does not collect data on living donor IR status. Given the feasibility of thorough living donor evaluation via already-mandated lab tests and clinical assessments, living donor IR assessment and associated disclosures may have limited benefit in improving recipient informed consent. Applying the current IR policy to living donors may also introduce unintended consequences to donors and recipients, causing donors psychological harm, delays in donation to avoid IR status disclosure, and potential withdrawal from donation. We suggest strategies that reduce risk of harm to donor candidates while maintaining policy compliance, and review additional approaches for evaluating risk of disease transmission in living donor candidates. Data on the risk of disease transmission by living donors are needed to inform policy modification.

Original languageEnglish (US)
Pages (from-to)3233-3239
Number of pages7
JournalAmerican Journal of Transplantation
Volume19
Issue number12
DOIs
StatePublished - Dec 1 2019

Keywords

  • donors and donation: donor evaluation
  • donors and donation: donor-derived infections
  • donors and donation: living
  • editorial/personal viewpoint
  • education
  • ethics and public policy
  • infectious disease
  • organ transplantation in general
  • risk assessment/risk stratification

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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