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Increase in organ donations likely a result of opioid epidemic; nearly all donations being tested
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In the United States, the proportion of organ donations made by donors at an increased risk for hepatitis B, hepatitis C and HIV infection has tripled since 2010, likely because of overdoses attributed to the opioid epidemic, but nearly all donations are now being tested, researchers said.
The opioid crisis has increased drug overdose deaths and acute HCV infections, Winston E. Abara, MD, PhD, MPH, from the CDC’s Division of Viral Hepatitis, and colleagues noted. As donations from increased-risk donors (IRDs) — including those who died from drug intoxication or who injected drugs — have risen in recent years, so has testing.
Abara and colleagues found that, as of 2017, nearly all donors were being screened using nucleic acid testing (NAT), highlighting the efforts being made to reduce the risk for unintended organ transplantation-associated viruses, such as HBV, HCV and HIV.
In 2013, the Public Health Service released guidelines categorizing donors who are at an increased risk for transmission, Abara and colleagues noted. For their study, they analyzed data from all deceased solid organ donors reported to the Organ Procurement and Transplantation Network between Jan. 1, 2010, and Dec. 31, 2017. They observed a 29.5% increase in deceased donors from 2010 to 2017, with 82.1% classified as standard risk donors (SRDs), 17.9% as IRDs, and less than 0.1% as having an unknown risk. According to the study, 59.6% of the donors were men and the median donor age was 39.9 years.
In 2010, 4.3% of donor deaths were the result of drug intoxication compared with 13.4% in 2017 (P < .001). Among these donors, a history of IV drug use increased from 1.3% to 8%. Total hepatitis B core antibody (anti-HBc) positivity among all donors decreased from 5% to 4.7%. Anti-HCV positivity among all donors increased from 4.2% to 7.3% and donors with anti-HIV positivity “increased slightly” from 0% to 0.1%.
Abara and colleagues also observed an increase in HCV RNA from 3.9% in 2014 to 4.9% in 2017.
According to the study, the proportion of deceased donors classified as IRDs increased from 8.9% in 2010 to 26.3% in 2017 (P < .001), and there was an increase in anti-HCV positivity from 15.9% to 21.6%.
Following the release of the revised organ donor testing guidelines, HCV and HBV RNA testing of IRDs increased from 4.6% in 2014 to more than 99.9% in 2017 and HIV NAT increased from 4.5% to 99.9%. Additionally, HCV RNA positivity increased from 8.6% to 15.7% and, overall, 5.3% were anti-HCV negative.
Among all deceased donors, the percentage of SRDs decreased from 90.1% in 2010 to 73.7% in 2017. Abara and colleagues reported anti-HBc positivity decreased from 4.7% in 2010 to 3.9% in 2017 and anti-HCV positivity also decreased from 3% to 2.2%. Moreover, HCV RNA decreased from 2.2% to 1.1%.
According to the study, HCV NAT testing among SRDs increased from 3.4% in 2014 to 100% in 2017, and, among all HCV RNA-positive donors, 3.5% were anti-HCV negative. Testing increased from 3.3% to 100% for HIV and HBV by NAT, despite it not being recommended for SRDs.
Abara and colleagues noted that IRDs were significantly more likely to be anti-HBc-positive, HBV DNA-positive, anti-HCV-positive and HCV RNA-positive compared with SRDS.
“Given advances in technology and universal NAT implementation among solid organ donors, CDC and [Health Resources and Services Administration] will continue to work with partners to review the current guideline recommendations to assess opportunities for refinement to reduce transmission of viral bloodborne pathogens and increase donor organ use,” they concluded. – by Marley Ghizzone
Reference:
Abara WE, et al. MMWR Morb Mortal Wkly Rep. 2019;doi:10.15585/mmwr.mm6803a2.
Disclosures: The authors report no relevant financial disclosures.