In a survey conducted in a large volume transplant center in the Southeastern United States, we found that most patients were willing to accept an offer for an HCV-infected kidney. In contrast to prior studies, our data demonstrate that there were no significant differences in willingness to accept offers for HCV-infected kidneys based on age and race. Our finding that majority of patients are interested in accepting an HCV-infected kidney is similar to what other groups who have found in their own patient population. However, in contrast to our findings, these studies found that older patients and white patients were more willing to accept HCV-infected kidneys than younger and black patients, respectively. [13, 14] The reason for the contrast in the results is unclear but may represent unmeasured differences in each transplant center’s characteristics and patient population.
While our study demonstrates that many patients are open to HCV-infected kidneys once educated regarding the safety and efficacy of DAA therapy post-transplant, they also suggest that other types of “high-risk” donation is less clear to patients. The majority of our respondents were unwilling to receive an organ from a donor with active IVDU at the time of death, albeit with negative HIV and HCV serologies. Similarly, the majority of our respondents were unwilling to receive an organ from an older donor with diabetes and hypertension, two disease states contributing to end-stage renal disease. In these scenarios, there may be an element of uncertainty regarding expected outcome for both the patient and the provider.
This lack of certainty is clearly problematic, as the designation of PHS-increased risk leads to non-utilization of hundreds of organs every year. [15] In focus groups, Ros et al found that patients desired additional information about PHS-increased risk donors, including behaviors, kidney quality, and probability of undetected infection. This study also found that patients heavily weighed the opinion of their transplant provider in making recommendations regarding organ offers. [16]
Participants in our survey received a modest amount of educational material regarding HCV-infected kidney offers and treatment prior to completing this anonymous survey. Given these data and other groups’ findings that patients prominently consider the opinion of the transplant provider in whether or not to accept an organ offer, we suggest that providers carefully consider the risks and benefits of an organ offer with their patients. These discussions should include consideration of patient age, current quality of life, and ability to detect and treat potentially transmitted infections.
This study has several limitations. First, our response rate was low (29%) and participation was voluntary. Therefore, it is possible that our findings are biased towards patients who are interested in HCV-infected kidneys in that these patients would be more likely to respond to this survey. Second, all respondents are listed at a single academic institution, which may limit the generalizability of the study. Third, the survey was designed to primarily gauge interest in accepting HCV-infected kidneys, hence no additional education within the survey was provided regarding the risks and benefits of accepting a PHS-increased risk or high KDPI kidney. However, patients did receive in-person education regarding these kidneys during their evaluation at our transplant center. Finally, due to the limited number of events and to avoid overfitting the model, some other potential confounders may not have been included in the multivariable analysis.