It should come as no surprise that there is a serious shortage of organ donors – as of late 2015 in the U.S., for example, the list of awaiting a transplant included over 122,000 names. There are not enough donors to meet the demand, and several different tactics are being considered to try to increase the number of available organs worldwide. A controversial new approach may be able to expand the number of available kidney donors: trials have just begun for the transplant of kidneys from donors with hep-C to patients who are hep-C free.
SERMO asked doctors from 18 nations for their thoughts:
63% of doctors said they would NOT recommend a patient in dire need of a kidney transplant to consider an organ from a donor infected with hep-C.
The response was not homogenous across countries – doctors from some countries felt more or less positively than others. Italy, for example, was close to the global average; 68% of Italian doctors would not recommend a kidney transplant with a hep-C positive donor. U.S. physicians, on the other hand, were more likely to recommend this course of action to patients – 46% of U.S. doctors said they would recommend such a transplant. Comparatively, doctors from France were significantly more wary of such a tradeoff. Three times the number of French doctors would not recommend as those that would.
In the dialogue about this topic on SERMO, doctors raised a variety of concerns with advising patients who need a kidney transplant – even those in dire need – to consider an organ from a hep-C positive donor.
A US Family Practice doctor remarked, “There are obvious ethical issues. Harvoni or other hep C meds don’t work 100%, and the few remaining percent of transplant pts on immunosuppressants could be harmed. Which is worse, ongoing ESRD/dialysis or immunosuppression in the face of hep C infection. Both are bad.”
A Canadian Pediatrician concurred succinctly: “I don’t think it would be ethical.”
A Mexican Surgeon agreed: “I do not think it’s ethical to resort to this practice.”
A US Vascular Surgeon opined that improvements to dialysis make kidney problems less critical than they formerly were: “Look, a liver is one thing, we can’t replace it and as liver failure worsens, you die. But with the ubiquitous availability of dialysis I cannot see the justification for the cost and risk. No, I would actively dissuade the vast majority of my renal failure patients from taking a Hep C positive donor kidney.”
An Argentinian Gastroenterologist stated, “I personally would not take the risk of putting my patient at risk.”
On the Contrary
Not all doctors were opposed to this trade – between improvements to hep-C care and massive shortages for organ donation, many doctors felt that the potential benefits outweighed the risks.
With the recent advancements to hep-C treatments, one Family Practice physician from the U.S. explained, “In light of the fact that we now have 95% cure rates for HCV, yes. But only as a last resort.”
A U.S. Gastroenterologist weighed out issues of informed consent, cost, survival rates, and quality of life, and ultimately concluded on a personal note: ‘If I was on dialysis and had the option to enter such a study, I would say ‘sign me up’.”
A GP from the U.K. pointed out that such studies are necessary to the advancement of patient care, explaining, “we need to do trials like this, with informed consent obviously – could be a cost and quality of life win all round.”
A Venezuelan Hematologist-Oncologist also felt that the trial was worth conducting: “[Its] good dare, to risk… with adequate therapy, it would save more lives. And there could be hope for others.”
A Psychiatrist from the U.S. who is personally acquainted with the process noted, “I do transplant evaluations so I have come to know many renal transplant recipients by now and I am 100% convinced that we should do everything we can to aid transplantation.”