The Impact on Organ Donation
The U.S. epidemic of opioid addiction and overdose has significantly impacted another major health crisis concerning the pressing need for life-saving organ transplants. The collision of the two crises has led to an increase in organ availability due to the generous gift of grieving families who have lost a loved one from a drug-related death. Quite often these deaths pose an increased risk of transplant-related infections.
What Qualifies as Increased Risk?
The phrase “Increased Risk” refers to the characteristics of an organ donor that could place the potential recipient at an increased risk of disease transmission. In 1994, the Centers for Disease Control (CDC) outlined what was known as “High Risk” criteria to address the behavioral risk factors associated with HIV. In 2013, the US Public Health Service (PHS) published new guidelines that would not only address HIV transmission but also the potential transmission of the Hepatitis B virus and Hepatitis C virus through organ transplantation.
There are a variety of exposures that carry different risks of transmitting infections that may cause a potential organ donor to be labeled as “Increased Risk.” To review the PHS Increased Risk Guidelines, visit https://optn.transplant.hrsa.gov/media/1163/2013_phs_guideline.pdf.
Additionally, in 2014, the United Network for Organ Sharing (UNOS) identified three additional criteria that classify a donor as “Increased Risk.”
- No Donor Risk Assessment Interview (DRAI) conducted (1)
- Hemodiluted Serology Specimen (2)
- Hemodialysis in the last 12 months (Increased Risk of Hepatitis C Only)
The Impact on Organ Transplantation
Despite the rapid increase in organ availability, utilization of these organs by transplant programs require additional considerations. These include weighing the risk of disease transmission, the experience and comfort level of transplant surgeons, medical-legal concerns, organ refusal by the potential recipients who have been informed of the increased risk, and the overall stigma associated with PHS increased risk designation.
To access tools on evaluating suitable recipients for PHS Increased Risk Organs, please visit http://transplantmodels.com/ird.