On June 25, federal government revised guidelines for organ transplants that will likely result in more organ donations, according to a press release from the Department of Health and Human Services (HHS) and the Public Health Service, which issued the guidance.

Notably, the update includes new criteria for identifying donors with potentially undetected HIV and hepatitis B and C viruses (HBV and HCV). Thanks in part to advances in testing and treatment, more organs can now be accepted from people who would have been classified as an increased risk donor (IRD).

More than 110,000 people are on transplant waiting lists in the United States, and, according to a report printed in the Morbidity and Mortality Weekly Report (MMWR), an increasing number of organs were going unused because they were considered to be at increased risk for HIV and hep B and C. This is in part because of the growing opioid epidemic. Not only are injection drugs a risk for the viruses, but the epidemic is also driving the number of deceased donors.

“Organ transplant candidates who are on the waiting list are at high risk for death, and those who decline IRD organs have higher rates of death and graft failure than patients who accept IRD organs,” according to the report in MMWR. “Because IRDs often are younger and have fewer comorbid conditions, they might have higher organ quality than standard risk donors.”

To address this issue and explore whether the guidelines should be revised, federal health officials sought feedback from community stakeholders, relevant experts and the public. The new guidelines will replace the 2013 recommendations. Other changes relating to HIV and hep B and C include:

  • the removal of any specific term to characterize donors with HIV, HBV or HCV infection risk factors;

  • universal organ donor HIV, HBV and HCV nucleic acid testing;

  • and universal posttransplant monitoring of transplant recipients for HIV, HBV and HCV infections.

These updates apply only to solid organ donors and not, for example, to blood products or breast milk or corneas. 

“This guideline brings us one step closer to shortening the national transplant waiting list and saving more lives,” said Admiral Brett P. Giroir, MD, assistant secretary for health, in the HHS press release. “It reflects the impressive advances in testing and treatment over the last seven years and provides actionable steps that will protect transplant patients from HIV and hepatitis B and C viruses.”

In related news, see the 2019 article “Organ Donors Increasingly Deemed High Risk for HIV, Hep B & C Transmission.”