1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, California.
2 Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, California.
The availability of highly effective direct-acting antiviral agent (DAA) medications for Hepatitis C virus (HCV) has led to reports of safely transplanting HCV+ donor lungs to HCV- candidates. However, it remains unclear how the ability to use HCV+ donor lungs for lung transplant could impact the number of donor lungs available for transplant. Using Scientific Registry of Transplant Recipient data we identified all deceased organ donors within the United States from March 1, 2015 to February 28, 2018 and stratified by HCV status. A donor prediction model for lung donation was derived and validated within HCV- donors and applied to HCV+ donors to estimate the number of acceptable HCV+ lung donors. Of 29,481 eligible donors, 2,054 (7.0%) were HCV+ donors with 82 HCV+ donors' lungs being utilized for transplant during the study period. The prediction model for donor lung donation (specificity 92.6%, sensitivity 65.6%) estimated 248 HCV+ donors (75 non-viremic, 173 viremic) were acceptable for lung transplant during the study period, suggesting that 166 acceptable HCV+ lung donors were discarded. The ability to transplant lungs from HCV+ organ donors would lead to an estimated nationwide increase of at least 55 donor lungs per year, including 44 from HCV viremic donors.