Doctors debate dangers of organs from ‘risky’ donors
An Australian expert is at the forefront of efforts to extend the range of lungs accepted for transplants.
‘‘Previously, we might have said taking organs from someone who has been a drug user or known to have hepatitis C in the past was too risky.’’
Professor Greg Snell
Lungs from patients with infectious diseases such as hepatitis C could soon be used in transplants across the ditch. And Australian experts aren’t ruling out accepting organs from HIV positive patients in the near future.
Professor Greg Snell, who heads the lung transplant service at Melbourne’s The Alfred hospital, said it was feasible lungs from donors with hepatitis C could be considered for donation within the next few years.
The Alfred is considered a world leader in lung transplantation. The hospital is responsible for all lung transplants in the states of Victoria, Tasmania, southern New South Wales and most of South Australia.
The hospital also carries out lung transplants for children across Australia and New Zealand.
Snell has been at the forefront of efforts to extend the types of lungs accepted for donation.
In Victoria, lungs are accepted from donors up to the age of 75.
In New Zealand, and the rest of Australia, the maximum age of lung donors is 70.
Snell said the next big barrier is taking lungs from donors who are hepatitis C positive.
‘‘Previously we might have said taking organs from someone who has been a drug user or known to have hepatitis C in the past was too risky,’’ Snell said.
‘‘We’re now in a position to say even if they have risky behaviour, even if the test was positive, we probably can go ahead and use those organs and transplant them, knowing the treatment for hepatitis C is one tablet a day, that has no side effects, for 12 weeks.’’
Snell expects such debates to become routine in the near future.
‘‘If someone is dying, sitting there on oxygen gasping away and you say there is a one in 50 chance you may get a virus that is treatable with 12 weeks of a single daily tablet, or you can sit and wait and hope another comes along, what would you do?’’
The Alfred’s lung transplant unit has carried out surgery on more than 1200 patients since 1990.
Snell said organs weren’t currently accepted from patients with HIV but, in theory, it could happen because the condition was treatable.
Dr Sam Radford, an intensivist (critical care specialist) at Melbourne’s Austin Hospital and Donate-Life Victoria’s deputy state medical director, said livers were already being accepted from donors with hepatitis C.
Those waiting for a lung and liver transplant could often die within a short timeframe and therefore clinicians were more willing to balance perceived risk versus the immediate risks.
Radford said Victoria had a reputation for being bold in the field of organ donation, thanks to the work of specialists such as Snell.
He could see doctors in the near future considering organs from donors who are HIV positive.
‘‘I’m grateful I don’t have to manage HIV as an illness but it looks like it’s becoming an increasingly manageable disease, a chronic disease people live with for decades, not dissimilar to diabetes,’’ Radford said.
‘‘You’ve got to say, why can’t we do this with an HIV positive patient? I’m sure it will offer meaningful outcomes to HIV positive donors and their families and I’m sure it will offer meaningful outcomes to recipients, regardless of their HIV status.
‘‘But no one in the transplant sector will go that way until we’ve got informed patients who understand the risk.’’
In New Zealand, 10 people are on the active waiting list for new lungs, 28 for a liver and 463 for kidneys.
Janice Langlands, donor coordinator at Organ Donation New Zealand, said kidneys and livers had already been taken from hepatitis C positive patients in this country.
However, to date, the organs had only been transplanted in hepatitis C positive recipients.
❚ Organs in a box A3