Disclosure of infectious risk to heart transplant candidates: Shared decision-making is here to stay

Abstract

The Public Health Service has defined 12 criteria of increased-risk (PHS-IR) for transmissible viral infections in potential organ donors where clinicians are required to document informed consent. Over the last decade, there has been a near tripling of PHS-IR donor organs in the United States. In light of the paucity in guidelines and consensus statements to guide clinicians on how to provide informed consent to potential recipients, using a typical case, we provide an overview including: how to effectively communicate infectious risk, whether clinicians should decline PHS-IR organs, the need to standardize disclosure practice across centers and finally how much information about the donor should be communicated to the transplant candidate. Many patients can be empowered by involving them in shared decision making to understand the minimal risk associated with the use of PHS-IR organs; an important step in improving donor utilization.

Keywords: HIV/HCV/HBV; PHS increased risk; donor utilization; heart transplantation; shared decision-making.