Using Hepatitis C-Positive Donors and Other High-Risk Donors

The growing pool of individuals awaiting lung transplantation has necessitated consideration of donors not previously utilized for transplantation. This includes donors at increased risk for infection with blood-borne pathogens, including human immunodeficiency virus, hepatitis B virus, and hepatitis C virus, and those known to have hepatitis B and/or C. Increased experience with these donors has demonstrated that their inclusion can safely expand the donor pool and shorten transplant waiting times. Donors with a history of hepatitis B virus infection who are surface antigen and DNA negative and those who are hepatitis C antibody positive and aviremic have been safely used without transmission of viral infection. Given the expanding treatment options for hepatitis C and increasingly successful use of hepatitis C-infected donors for kidney, heart, and liver transplantation, hepatitis C-infected and -viremic donors are now being considered for lung donation. Preemptive and prophylactic strategies utilizing directly active antivirals beginning either in the perioperative or postoperative periods have both been effective in curing hepatitis C when studied in clinical trials of intentional donor-transmitted hepatitis C. Close monitoring of viral response and adverse effects is required if hepatitis C-viremic donors are going to be used. Education about these viruses and the impact of receiving an increased risk or infected donor on wait times and outcomes are recommended for all candidates, and appropriate consent processes outlining risks should be included prior to transplantation with a transplant from a donor with known or risk for these infections.