DAAs Make Possible Transplant of HCV Positive Organs
DAAs have made the risk of HCV infection both manageable and ethically acceptable.
Gavin Cloherty, PhD
More than 100,000 Americans are on the organ donor list, and the vast majority need kidneys. Around 17,000 Americans actually receive a kidney transplant every year, while almost 5,000 die waiting.
The current guidelines and DAA drugs
New research has reported that new DAA drugs may hold the key to making many more organs available to waiting patients.
Under the current guidelines, hepatitis C virus (HCV) positive organs may not be transplanted into healthy patients. The adverse effects of infecting a transplant recipient with HCV outweigh the benefits of receiving the organ.
Study findings based on a virtual trial
But, direct-acting antiviral drugs (DAAs) have changed that. Using DAAs, physicians can now cure HCV in greater than 90% of cases. Although this approach still carries some risk that the patient won’t be cured, the odds are firmly in favor of the organ recipient. DAAs have made the risk of HCV infection both manageable and ethically acceptable.
This study was conducted virtually by researchers at Massachusetts General Hospital (MGH). This was a time-saving measure because a randomized clinical trial investigating the use of HCV-positive organs in HCV-negative patients could take years.
The MGH team simulated the life courses of healthy patients on the waiting list and compared 2 scenarios:
- Waiting for an HCV-negative liver
- Agreeing to accept any appropriate organ, with antiviral treatment begun if an HCV-positive liver is used.
Their analysis confirmed that the benefits far outweighed the risks of accepting an HCV-positive liver in the majority of patients. Gavin Cloherty, PhD, director of Infectious Disease Research for Abbott’s diagnostics business, told MD Magazine that the findings are very interesting, and virtual studies serve as a good barometer.
A moral dilemma
“I also believe it’s worth following up and doing additional research in practice to understand if the findings bear out in reality,” Cloherty said.
According to information from the United Network for Organ Sharing (UNOS), a non-profit that manages the United States’ organ transplant system, 2017 was the fifth straight record-setting year for US organ transplants.
Organ donation can only happen when the cause of death stops brain function while leaving the body’s other organs intact — albeit on life support. This is the case in drug overdoses when patients are resuscitated after too much time without breathing.
On patients seeming to benefit from the drug crisis, Cloherty was confident.
“People have already made the decision to be a donor,” Cloherty said. “Then, you’re also taking something tragic like the opioid epidemic, and if there’s something positive that can come from it, then I think that can only be positive.”
Salvaging HCV-positive organs that would otherwise have been discarded is a game-changing development.
“It’s exciting times, not just for liver transplant as indicated in this study, but also hearts, kidneys and everything else," Cloherty said.
The study, "Transplanting HCV-positive livers into HCV-negative patients with preemptive antiviral treatment: A modeling study," was published online in the journal Hepatology.
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