Schweitzer EJ et al. (2007) Estimated benefits of transplantation of kidneys from donors at increased risk for HIV or hepatitis C infection. Am J Transplant 7: 1515–1525

Interpretation by medical practitioners of the transplantation guidelines of the US Centers for Disease Control and Prevention leads most to discard kidneys from potential donors who have behavioral risk factors for HIV or hepatitis C virus (HCV) infection, even if screening tests for the viruses are negative. These guidelines are, however, now over a decade old, and clinical developments, including the increasing availability of rapid and more-sensitive infection screening, might mean that organs from these increased-risk donors (IRDs) could safely be used to expand the current pool of donated kidneys. A recent Markov model analysis suggests that kidneys from IRDs who are seronegative following screening for HCV and HIV nucleic acids should be considered for use as allografts.

In comparison with a policy of discarding kidneys from IRDs, a policy of transplanting organs from seronegative (according to both antibody and nucleic-acid testing) IRDs resulted in 20-year improvements in the number of patients who received transplants, waiting time, time with functioning graft, cost of care, and recipient survival, as well as in a greater number of quality-adjusted life-years. Importantly, the discard policy resulted in a higher 20-year incidence of infection overall, attributable to the increased time spent by potential graft recipients on maintenance hemodialysis (which is associated with relatively high risks of acquiring HCV infection). Incidence of HIV infection was, however, higher with the transplant policy than with the discard policy, and the infection rate advantage of using organs from IRDs was lost when nucleic acid screening for HIV and HCV was unavailable.