Department of Surgery, Johns Hopkins University School of Medicine.
Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA.
Curr Opin Nephrol Hypertens. 2018 Nov;27(6):445-453. doi: 10.1097/MNH.0000000000000456.
Due to the organ shortage, which prevents over 90 000 individuals in the United States from receiving life-saving transplants, the transplant community has begun to critically reevaluate whether organ sources that were previously considered too risky provide a survival benefit to waitlist candidates.
Organs that many providers were previously unwilling to use for transplantation, including kidneys with a high Kidney Donor Profile Index or from increased risk donors who have risk factors for window period hepatitis C virus (HCV) and HIV infection, have been shown to provide a survival benefit to transplant waitlist candidates compared with remaining on dialysis. The development of direct-acting antivirals to cure HCV infection has enabled prospective trials on the transplantation of organs from HCV-infected donors into HCV-negative recipients, with promising preliminary results. Changes in legislation through the HIV Organ Policy Equity Act have legalized transplantations from HIV-positive deceased donors to HIV-positive recipients for the first time in the United States.
Critical reexamination of deceased donor organs that were previously discarded has resulted in greater utilization of these organs, an increased number of deceased donor transplants, and the provision of life-saving treatment to more transplant waitlist candidates.
由于器官短缺，美国超过 9 万人无法接受救命的移植手术，移植界开始重新审视之前被认为风险过高的器官来源是否能为等待移植名单上的候选人提供生存获益。
许多提供者之前不愿意用于移植的器官，包括肾源的 Kidney Donor Profile Index 较高，或来自窗口期丙型肝炎病毒（HCV）和 HIV 感染风险增加的供体，与继续接受透析相比，为移植等待名单上的候选人提供了生存获益。直接作用抗病毒药物治疗 HCV 感染的发展，使 HCV 感染供体向 HCV 阴性受者移植器官的前瞻性试验成为可能，初步结果令人鼓舞。《HIV 器官政策公平法案》（HIV Organ Policy Equity Act）的立法变革，首次使美国合法化了从 HIV 阳性已故供体向 HIV 阳性受者进行移植。
对以前被丢弃的已故供体器官进行重新审视，导致这些器官的利用率增加，更多的已故供体移植，为更多的移植候补名单上的候选人提供了救命治疗。
