ABSTRACT
Increased viral risk donors (IVRDs) with increased risk behaviors for blood-borne virus infection and negative nucleic acid testing have a low absolute risk of "window period" infection. Utilization and allocation of IVRD organs differ between jurisdictions. METHODS: We examined the characteristics and utilization of deceased donor IVRD kidneys and recipient outcomes within a 2-y period (July 31, 2018-July 31, 2020) postimplementation of a new opt-in allocation pathway for preconsented recipients in Victoria, Australia. RESULTS: Fifty-six kidneys from 31 IVRDs were utilized, comprising 13% of donors. Preconsent rate to accept IVRD kidneys increased to 41% of the waitlist in the 2 y postimplementation, and IVRDs having no kidneys utilized reduced to 0%. Compared with non-IVRD kidneys, kidney offer declines >10 per donor were less likely from IVRDs (3% vs 19%; P < 0.05). IVRDs were younger (median age 36 [IQR 30-44] vs 51 [35-60] y; P < 0.0001), with lower kidney donor profile index (25% [13-40%] vs 57% [29-75%]; P < 0.0001), and less hypertension (0% vs 22%; P < 0.01). Estimated glomerular filtration rate 3 mo post-transplant was superior (P < 0.01). Injecting drug use (61%) was the most common increased risk behavior. 29% of IVRDs were hepatitis C antibody positive but nucleic acid testing negative. No active infection was detected in any recipient post-transplant. CONCLUSIONS: The described opt-in system permits efficient allocation and utilization of kidneys from IVRDs, with superior quality and graft function. Education is crucial to facilitate informed consent and equity of access to this donor pool.
ABSTRACT
Background: Deceased organ donation work-up typically takes 24 hours or more. Clinicians may thus discount the possibility of donation when the potential donor is physiologically unstable or family requirements do not allow this length of time. This may lead to loss of transplantable organs. In 2015, we introduced an expedited work-up guideline with the aim of facilitating donation in these circumstances and maximising donation potential. Objective: To determine the number of expedited work-up (consent to retrieval procedure of 6 hours or less) donors from 2015 to 2018, compare their clinical and demographic characteristics with standard donors, and assess the outcome of transplanted organs and organ recipients. Design: We performed a retrospective audit of the electronic database for all Victorian donors from 2015 to 2018. We obtained transplant outcome data from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). Results: Overall, 38 expedited pathway donors donated 78 organs for transplantation (70 kidneys, four lungs, three livers, one pancreas). Of these, 55 retrieved kidneys were successfully transplanted. The lungs, livers and pancreas retrieved were all transplanted. For the kidney recipients, early graft dysfunction requiring dialysis was more common than with organs from the standard pathway (71% v 38%; P < 0.0001); however, short and medium term graft and patient survival were similar. Three recipients from the expedited pool experienced graft failure and two subsequently died. Of the two lung recipients, one died at day 622 of chronic rejection. Conclusions: Expedited pathway donation is feasible with acceptable donation outcomes. Clinicians should consider donation even when physiological instability or family requirements preclude standard organ donation work-up times.
