Organs with hepatitis C can now be transplanted

“The long and short of it is the big limitation in getting patients transplants is the availability of donors,” Dr. Sciortino said.

He recalled one woman at UPMC who waited three months for a heart before a hepatitis C heart became available. “Before, that heart wouldn’t have been used at all. Now — she’s doing great.”

The CDC estimates that 3.5 million people in the United States have hepatitis C, meaning they have been exposed to the virus and are producing antibodies to fight it. Not everyone with hepatitis C antibodies will go on to develop the virus, and between 15 percent and 20 percent will clear the virus without needing treatment.

The rest are considered to have chronic hepatitis C, putting them at risk for developing an active virus that, left untreated, can cause cirrhosis and liver cancer and impair the kidneys. The CDC says that hepatitis C kills more Americans than any other infectious disease.

Decades ago, people testing positive for hepatitis C were not automatically rejected as organ donors under the theory that it could take years, even decades, for the virus to develop. Compared with the immediate perils of a failing organ, the risk seemed worth it.

But according to Dr. Klassen, use of hepatitis Cinfected organs fell out of favor, and the practice all but stopped. An exception was made for recipients who already had tested positive for hepatitis C.

Before 2014, there were treatments for hepatitis C, but they had harsh side effects and their cure rate was no better than 45 percent.

But in 2013, drugmakers received federal approval for a new generation of direct-acting antiviral medications that boasted cure rates above 95 percent, virtually no side effects and a 12-week treatment period. This is compared with older drugs that could take up to a year.

However, the new drugs came with jaw-dropping price tags — as much as $168,000 for a full course of treatment.

The price rattled insurers and prompted sharp criticism from patients and public officials. Medicaid agencies restricted who could receive the new drugs, reserving them for patients considered the sickest and those abstaining from alcohol. They also limited prescribing privileges to certain medical specialties.

With more competition, the price of antivirals has dropped. Many Medicaid agencies lowered their requirements for how sick a patient had to be (measured by liver damage), and at least 17 dropped the requirement altogether.

At least two states, California and Oregon, have removed restrictions for Medicaid patients who have undergone transplants. Few commercial insurers have similar guarantees.

Several transplant physicians around the country said that if insurers have refused to pay for the antiviral medications, their hospitals have covered the expenses themselves, sometimes with the help of donations. But payment remains a concern for transplant centers. Some of these centers automatically provide hepatitis C treatment for transplant patients who received an infected organ. Others wait for signs that the transplanted patient is developing the virus.

“Every center feels strongly that they need to be able to guarantee treatment” for hepatitis C, said Emily Blumberg, director of the transplant infectiousdiseases program at the Hospital of the University of Pennsylvania.

Spending the money is good public policy, Vanderbilt’s Dr. Schlendorf said.

“What needs to be considered is the cost of not getting a transplant quickly,” she said. “It means more days in the [intensive care unit] waiting and more time on a heart pump. Those are more expensive than a course of hep C medicine.”