Department of Coordinated Care, University of Wisconsin Madison, Madison, Wisconsin.
Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Am J Transplant. 2019 Dec;19(12):3233-3239. doi: 10.1111/ajt.15541. Epub 2019 Aug 14.
Donor-derived human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV) transmissions in transplantation have led to policies mandating assessment of donor behavioral history, and disclosure of donor increased risk (IR) status to recipients. Organ Procurement Transplantation Network (OPTN) policy safeguards were promulgated in the context of deceased donation, with its narrow time window for organ utilization and uncertainty about donor history. These policies have been applied to living donation without substantive data on risk of disease transmission in living donor transplantation. Unlike for deceased donors, the OPTN does not collect data on living donor IR status. Given the feasibility of thorough living donor evaluation via already-mandated lab tests and clinical assessments, living donor IR assessment and associated disclosures may have limited benefit in improving recipient informed consent. Applying the current IR policy to living donors may also introduce unintended consequences to donors and recipients, causing donors psychological harm, delays in donation to avoid IR status disclosure, and potential withdrawal from donation. We suggest strategies that reduce risk of harm to donor candidates while maintaining policy compliance, and review additional approaches for evaluating risk of disease transmission in living donor candidates. Data on the risk of disease transmission by living donors are needed to inform policy modification.
供体来源的人类免疫缺陷病毒 (HIV)、丙型肝炎病毒 (HCV) 和乙型肝炎病毒 (HBV) 在移植中的传播导致了要求评估供体行为史并向受者披露供体增加的风险 (IR) 状态的政策。器官获取移植网络 (OPTN) 政策保障是在已故供体的背景下颁布的，其器官利用的时间窗口狭窄，供体病史不确定。这些政策已适用于活体捐献，但缺乏活体捐献者移植中疾病传播风险的实质性数据。与已故供体不同，OPTN 不收集活体供体 IR 状态的数据。鉴于通过已经规定的实验室检测和临床评估对活体供体进行彻底评估的可行性，活体供体 IR 评估和相关披露可能对改善受者知情同意的作用有限。将现行的 IR 政策应用于活体供体可能会给供体和受体带来意想不到的后果，导致供体心理伤害、为避免 IR 状态披露而延迟捐献，以及潜在的捐献退出。我们建议采取一些策略，在遵守政策的同时减少对供体候选人的伤害风险，并审查评估活体供体候选人疾病传播风险的其他方法。需要有关活体供体传播疾病风险的数据来为政策修改提供信息。
