Transplantation Direct (Aug 2022)

Decision-making Among Hepatitis C Virus-negative Transplant Candidates Offered Organs from Donors with HCV Infection

  • M. Elle Saine, MD, PhD,
  • Erin M. Schnellinger, PhD,
  • Michel Liu, BS,
  • Joshua M. Diamond, MD, MSCE,
  • Maria M. Crespo, MD,
  • Stacey Prenner, MD,
  • Vishnu Potluri, MD, MPH,
  • Christian Bermudez, MD,
  • Heather Mentch, MBE,
  • Michaella Moore, MA,
  • Behdad Besharatian, MD,
  • David S. Goldberg, MD, MSCE,
  • Frances K. Barg, PhD, MEd,
  • Peter P. Reese, MD, MSCE

DOI
https://doi.org/10.1097/TXD.0000000000001341
Journal volume & issue
Vol. 8, no. 8
p. e1341

Abstract

Read online

Background. Historically, many organs from deceased donors with hepatitis C virus (HCV) were discarded. The advent of highly curative direct-acting antiviral (DAA) therapies motivated transplant centers to conduct trials of transplanting HCV-viremic organs (nucleic acid amplification test positive) into HCV-negative recipients, followed by DAA treatment. However, the factors that influence candidates’ decisions regarding acceptance of transplant with HCV-viremic organs are not well understood. Methods. To explore patient-level perceptions, influences, and experiences that inform candidate decision-making regarding transplant with organs from HCV-viremic donors, we conducted a qualitative semistructured interview study embedded within 3 clinical trials investigating the safety and efficacy of transplanting lungs and kidneys from HCV-viremic donors into HCV-negative recipients. The study was conducted from June 2019 to March 2021. Results. Among 44 HCV-negative patients listed for organ transplant who were approached for enrollment in the applicable clinical trial, 3 approaches to decision-making emerged: positivist, risk analyses, and instinctual response. Perceptions of risk contributed to conceptualizations of factors influencing decisions. Moreover, most participants relied on multiple decision-making approaches, either simultaneously or sequentially. Conclusions. Understanding how different decisional models influence patients’ choices regarding transplant with organs from HCV-viremic donors may promote shared decision-making among transplant patients and providers.