Hepatitis C infection in cadaver organ donors: strategies to reduce transmission of infection and prevent organ waste.

The transmission of hepatitis C virus (HCV) by organ transplantation has been unequivocally demonstrated. Among recipients of organs from anti-HCV-positive donors, 57%-96% test positive for HCV RNA. Consequently, several organ procurement organizations have adopted a policy restricting the use of anti-HCV-positive donors to life-saving transplants (heart, liver, or lung). The differences in the rate of transmission of HCV infection by anti-HCV-positive donors could be related to the prevalence of HCV RNA among these donors. In a national collaborative study of 3,078 cadaver organ donors from eight organ procurement organizations in the United States, the prevalence of anti-HCV antibodies and HCV RNA were 4.2% and 2.4%, respectively. The sensitivity and negative predictive value of anti-HCV antibodies for HCV RNA were 100%. However, despite a specificity of 98.1%, the positive predictive value was only 55.1%. Discarding organs from enzyme-linked immunosorbent assay 2-positive donors would eliminate transmission, but organs from 1.88% of donors would be wasted. Clinical and laboratory characteristics did not distinguish anti-HCV-positive donors with and without HCV RNA. Hence, to reduce waste it is necessary to develop confirmatory tests with a higher specificity for HCV RNA than those that are currently available. Even if anti-HCV-positive but HCV RNA-negative donors could be identified and utilized, 2.4% of cadaver organ donors that test positive for serum HCV RNA would remain unsuitable for transplantation of non-life-saving organs. Hence, several authors have suggested the use of kidneys from anti-HCV-positive donors in recipients with pre-existing HCV infection.(ABSTRACT TRUNCATED AT 250 WORDS)