UW Medicine specialists refine a progressive option for people awaiting donor organs.

In the first year of a new protocol, UW Medicine specialists transplanted 13 patients with donor organs – seven hearts and six livers – from people who had active hepatitis C before they died.

“Twelve people are alive today who may not have survived otherwise because they didn’t get a donor,” said Dr. Ajit Limaye. He directs the Solid Organ Transplant Infectious Disease Program, whose team is charged with ensuring that donor organs and their intended recipients are safe from the many pathogens that can be transmitted by transplant.

Nine organ recipients have completed the antiviral meds or are in process, three organ recipients have not yet started the medication regimen, and one patient died immediately after transplant of complications unrelated to hepatitis C.

Limaye attributed the program's success to comprehensive planning. “There was trepidation about how patients would do, whether insurance companies would pay for the antivirals, will there be enough donors, will transplant candidates say yes to such a donor organ. All of those very logical questions, and many others, needed to be addressed upfront.”

Under the protocol, doctors at UW Medical Center discuss the availability of hep C-infected donor organs with patients awaiting heart or liver transplants.  Historically such organs have been declined for transplant or considered only for recipients who already had the infection – but not with the idea that a cure was possible.

“What I hear initially from patients is surprise, like ‘Why are you talking about giving me hepatitis C? Don’t you screen donors to prevent that?’” Limaye said.

 

With education, most patients come to understand that opting into the protocol increases their chance for a donor organ and that almost all cases of hep C are curable. Patients who decline the option, perhaps perceiving that a “healthier” organ will become available, tend to wait longer for a transplant and die sooner, on average, than those who accept the infected organs, research shows.

When an appropriate matching donor organ becomes available, the patient is asked again. Post-transplant, the hep C-infected recipient must undertake a two-month daily drug regimen and submit to multiple blood draws to confirm the decline in viral load – this, in addition to the typical postoperative checkups to monitor the health of the transplanted organ.

Limaye hesitated to project the number of patients that might benefit from these organs in the next few years. Ultimately, he said, the goal would be to expand the hep C protocol beyond heart and liver, to all donor organs. But data is needed first about the long-term outcomes of patients who have received such a transplant – still a relatively small number.

“It’s just a small group of transplant centers nationwide that offer this, and our patients are grateful that we’re among them,” Limaye said. “But it’s complicated stuff: It requires specialists in liver care, to manage the hep C drug regimens, pharmacists to figure out drug interactions and dosages, the transplant units specific to the organ, and the infectious disease team.

“And we’re still refining the process for these cases. For example, does it make sense to start the patient on the antiviral at the time of transplant, so the regimen post-transplant could potentially be shortened? There are still unknowns, but our first year gives us a lot of hope.”