Landscape of Deceased Donors Labeled Increased Risk for Disease Transmission Under New Guidelines

Abstract

Deceased donors are labeled increased risk for disease transmission (IRD) if they meet certain criteria. New PHS guidelines were recently implemented; the impact of these changes remains unknown. We aimed to quantify the impact of the new guidelines on the proportion of deceased donors labeled IRD, as well as demographic and clinical characteristics. We used Poisson regression with an interaction term for era (new vs. old guidelines) to quantify changes. Under the new guidelines, 19.5% donors were labeled IRD, compared to 10.4%, 12.2%, and 12.3% in the 3 most recent years under the old guidelines (IRR = 1.45, p < 0.001). Increases were consistent across OPOs: 44/59 had an increase in the percent of donors labeled IRD, and 14 OPOs labeled 25% of their donors IRD under the new guidelines (vs. 5 OPOs under the old). African-Americans were 52% more likely to be labeled IRD under the new guidelines (RR = 1.52, p = 0.01). There has been a substantial increase in donors labeled IRD under the new PHS guidelines; it is important to understand the mechanism and consequences to ensure an optimal balance of patient safety and organ utilization is achieved.

Keywords: Donors and donation: donor-derived infections; guidelines; infection and infectious agents; viral: hepatitis C; viral: human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS).

Figure 1

Percent of Donors Labeled IRD, by Year

Figure 2

Percent of Donors Labeled IRD Under (a) Old Guidelines*, and (b) New Guidelines; Percent of Transplant Volume from Donors Labeled IRD Under (c) Old guidelines*, and (d) New guidelines, by OPO

Figure 3

Histogram of Absolute Difference in OPO (a) Percent of Donors Labeled IRD, and (b) Percent of Transplants from Organs Labeled IRD Under New Guidelines