Faced with a shortage of donor hearts, transplant centers have had to expand their criteria for acceptable organs.
"We are an unhealthy society,” says Dr. Shelley Hall, chief of transplant cardiology at Baylor University Medical Center. “Our donors are sicker. They have more medical conditions so their organs aren’t as suitable after they’re braindead.”
Add to that safety laws good for population health, and Hall says, you have more and more people requiring heart transplantation than ever while donors aren’t increasing exponentially to match.
“If we look at the donors that we take now, these are donors we would have denied 20 years ago as not good enough,” Hall says.
However, she says treatment has advanced enough for clinical trials to determine if organs from hepatitis C donors could possibly come off the rejection list.
“Now, with an explosion of antiviral medications for hepatitis C, it’s now at a 98 to 99 percent cure rate,” she says.
That means heart recipients who develop the virus soon after a transplant would likely be cured.
Why there's a shortage of donors: We are an unhealthy society. Our donors are sicker. They have more medical conditions so their organs aren’t as suitable after they’re braindead. The second is we’ve passed a lot of safety laws, which are obviously good for population health with helmet laws and seat belt laws. So, we have more and more people requiring heart transplantation than ever, and at a time when our donors are not increasing exponentially to match.
Change in criteria for acceptable hearts: If we look at the donors that we take now, these are donors we would have denied 20 years ago as not good enough. And now every transplant center in the country tries to make every donor organ offered useful. We still have a very high discard rate. Depending on the area of the country, it can be as high as 50 percent of the donors are denied.
Patient worries about hepatitis C donors: Hepatitis C has a visceral response of fear because 10 years ago we had no treatment. And patients that had hepatitis C were going through very rough treatments that had OK results if you could get through the treatments — sort of like chemotherapy for cancer. However, now with an explosion of antiviral medications for hepatitis C, it’s now at a 98 to 99 percent cure rate. It is now no longer the leading cause of liver transplants.
And so now, all of a sudden, we have a curable disease that completely changes our landscape for potential donors, because donors have other viruses that are out in the community that we have no cure for and we take those every day and we just deal with those viruses. They are viruses that cause colds in you or me, but in a transplant patient, can cause some significant infections. But if we were to say no to all of those, we’d have no transplantation at all. So, hepatitis C is actually one of the few viruses we can cure after the transplant if the virus transmits to the recipient.
When recipient gets antiviral medications: Most centers now that are exploring it are waiting and checking to see when the patient turns positive because there is a small percentage that may not turn positive. But the vast majority are going to turn positive and replicate the virus, and then when they go through the antiviral treatment varies from the same hospitalization, like within a week of turning positive to three months later when they’re out of the hospital, because the virus rarely hurts somebody acutely. It’s the chronic exposure over years that damages the liver. So, more transplant centers are delaying their antiviral treatment longer to let the patient recoup from their transplant, have their other medications settle down, and then be able to cleanly initiate the antiviral treatment.