Transplant shortcut: Infected organs
Sick patients have little time and no alternative
David Blackshear was born with only one kidney. The 70-year-old Arizona man didn’t seriously worry about it until this summer, when it began to fail.
His doctors told him he had a choice.
He could start dialysis and wait up to five years for an organ transplant. Or he could take a shortcut: He could accept a donor kidney infected with hepatitis C.
“I was not too thrilled about the dialysis,” said Blackshear of Surprise, Arizona. He feared his quality of life would be limited by frequent trips to a center to be hooked up to a blood-cleansing machine for hours at a time.
He agreed to take the infected kidney: “I had no other alternative.”
It cut the wait from five years to two weeks. Blackshear received his transplant at Banner University Medical Cen-
ter in Phoenix in July. This month, he’ll begin taking antiviral drugs to rid his body of signs of the virus.
Hospitals have long discarded organs donated by patients infected with hepatitis C. But in light of a new class of direct-acting antiviral drugs that can cure the infection – and an opioid crisis that’s produced thousands of potential donors with the virus – doctors at several prestigious hospitals are transplanting infected organs into people who don’t have the virus.
People who get the infected organs must take an expensive drug over eight to 12 weeks to remove signs of the virus from their blood. A trio of recent, small studies suggest that the operation is usually successful.
Recipients must give consent to take an organ infected with a potentially deadly virus. The Centers for Disease Control and Prevention estimates that hepatitis C caused or contributed to more than 18,000 deaths in 2016.
Wait time substantially lessened
Doctors said expanding the pool of usable organs can save lives.
For example, more than 95,000 Americans are candidates for a kidney, the most common type of organ transplant, according to the Department of Health and Human Services. Nearly
4,800 people died in 2014 waiting for a transplant.
Thousands of others are considered too sick to get a transplant.
“Many will not live long enough by the time their name gets to the top of the list,” said Niraj Desai, a transplant surgeon at Johns Hopkins Medicine in Baltimore.
As more young adults died from heroin and fentanyl overdoses, doctors became frustrated when otherwise-healthy organs were tossed out because they were infected with hepatitis C.
Nearly 2,700 kidneys infected with the virus were thrown out from 2005 to
2014, University of Pennsylvania nephrologist Peter Reese reported in the New England Journal of Medicine.
That’s changed in recent years. Infected organs were transplanted into nearly 500 noninfected patients in 2017, according to the United Network for Organ Sharing.
Why now? A handful of doctors and hospitals have grown comfortable doing these transplants because antiviral drugs can clear signs of the virus.
‘A second chance of living’
Holly Licht’s worsening heart condition put her at Vanderbilt University Medical Center’s intensive care unit in early 2017.
The Crossville, Tennessee, woman, an office coordinator for a physical therapy practice, needed a new heart soon. Doctors explained she could get a transplant more quickly if she agreed to accept an infected organ.
“I’ve been in the medical field for over 20 years,” Licht said. “I didn’t know if I wanted a high-risk, hepatitis C donor.”
Vanderbilt doctors explained that antiviral drugs cleared the virus in nearly all patients. Licht knew time wasn’t on her side. She had waited two years for a donor heart when she had her first transplant in the 1990s.
She accepted an infected heart in March 2017 and completed three months of treatment with the hepatitis C-attacking drug Harvoni. She’s been tested every three months since then, and there have been no signs of the virus.
“I don’t take much for granted now that I have a second chance of living,” Licht said.
Drugs remain costly
The cost of medications remains a challenge.
When Gilead Sciences obtained Food and Drug Administration approval to market its drug Sovaldi in
2013, the company priced the drug at
$84,000 for a 12-week course. Gilead later came out with Harvoni, a more expensive combination pill that combined two antivirals.
Other hepatitis C drugs, such as AbbVie’s Viekira Pak and Merck’s Zepatier, are similarly costly.
Blackshear said he wasn’t worried about the cost of the antiviral drugs. He just wanted a new kidney – and a longer life.
“I’m doing so much better now,” he said. “Who would have thought I’d get a kidney in two weeks?”