Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
Health Resources and Services Administration, Rockville, Maryland.
Am J Transplant. 2019 Sep;19(9):2560-2569. doi: 10.1111/ajt.15388. Epub 2019 May 3.
Under US Public Health Service guidelines, organ donors with risk factors for human immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV) are categorized as increased risk donors (IRD). Previous studies have suggested that IRD organs are utilized at lower rates than organs from standard risk donors (SRD), but these studies were conducted prior to universal donor nucleic acid test screening. We conducted risk-adjusted analyses to determine the effect of IRD designation on organ utilization using 2010-2017 data (21 626 heart, 101 160 kidney, 52 714 liver, and 16 219 lung recipients in the United States) from the Organ Procurement and Transplantation Network. There was no significant difference (P < .05) between risk-adjusted utilization rates for IRD vs SRD organs for adult hearts and livers and pediatric kidneys, livers, and lungs. Significantly lower utilization was found among IRD adult kidneys, lungs, and pediatric hearts. Analysis of the proportion of transplanted organs recovered from IRD by facility suggests that a subset of facilities contribute to the underutilization of adult IRD kidneys. Along with revised criteria and nomenclature to identify donors with HIV, HBV, or HCV risk factors, educational efforts to standardize informed consent discussions might improve organ utilization.
根据美国公共卫生服务指南，具有人类免疫缺陷病毒 (HIV)、乙型肝炎病毒 (HBV) 或丙型肝炎病毒 (HCV) 风险因素的器官捐赠者被归类为增加风险供体 (IRD)。先前的研究表明，IRD 器官的利用率低于标准风险供体 (SRD) 的器官，但这些研究是在普遍进行供体核酸检测筛查之前进行的。我们使用 2010-2017 年美国器官获取和移植网络的数据（21626 例心脏、101160 例肾脏、52714 例肝脏和 16219 例肺移植受者）进行了风险调整分析，以确定 IRD 分类对器官利用的影响。成人心脏和肝脏以及儿科肾脏、肝脏和肺的 IRD 与 SRD 器官的风险调整利用率之间没有显著差异 (P<0.05)。IRD 成人肾脏、肺和儿科心脏的利用率明显较低。对设施从 IRD 回收的移植器官比例的分析表明，一部分设施导致成人 IRD 肾脏的利用率降低。随着识别具有 HIV、HBV 或 HCV 风险因素的供体的标准和命名法的修订，开展标准化知情同意讨论的教育工作可能会提高器官利用率。
