Deceased organ donors and PHS risk identification: impact upon organ usage and outcomes.

Background: In 2013, the PHS changed the criteria intended to identify organ donors that put the associated organ recipients at increased risk for acquiring HIV, HBV and HCV. The changing donor demographics, organ utilization and outcomes associated with this change is not known. Methods: A review of the OPTN database was performed to assess the impact of PHS donor designation upon organ utilization and outcomes. Results: After the 2013 modification, over 20% of all deceased organ donors in the US were identified as PHS increased risk. Compared to the standard risk deceased organ donor, the PHS donor was younger, male, died from anoxia, more likely to be HCV and HBcAb+ and less likely to have diabetes or hypertension. Organs from the 18 to 34-year-old deceased donors with PHS risks (but relatively few medical comorbidities) and tested negative for HCV were less frequently transplanted compared to the standard risk donors, 3.9 vs 4.2 OTPD. However, the transplant patient and graft survival as well as risk of unexpected transmission of HIV, HBV and HCV were equivalent, irrespective of PHS donor status. Conclusion: The rationale of using PHS donor designation that negatively impacts utilization of high quality organs without the benefit of identifying the subset of organs with demonstrable proclivity to transmit HIV, HBV or HCV needs to be re-examined. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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