Organ wait list shortcut: Patients accepting kidneys, hearts infected with hepatitis C

Health, Fitness & Food

David Blackshear was born with only one kidney. But 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.

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“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 Center 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 who were infected with hepatitis C. But with 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 of the nation’s most prestigious hospitals are transplanting infected organs into people who don’t already have the virus.

People who get the infected organs must take an expensive drug over 8 to 12 weeks to remove signs of the virus from their blood. But 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.

Doctors say 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 U.S Department of Health and Human Services. But 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 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. “This substantially lessens the wait time.”

With more young adults dying 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 between 2005 and 2014, University of Pennsylvania nephrologist Peter Reese reported in the New England Journal of Medicine.

“There are a lot of people dying of opioid overdoses who want to donate their organs,” Reese told USA TODAY.”We are burying thousands of organs that can be used for transplant.”

Doctors long avoided giving organs with hepatitis C to patients who weren’t already infected.

That’s changed in recent years. Infected organs were transplanted into nearly 500 non-infected patients in 2017, according to the United Network for Organ Sharing, a more than tenfold increase over 2015.

Why now? A handful of doctors and hospitals have grown comfortable doing these transplants because antiviral drugs can clear signs of the virus.

Brigham and Women’s Hospital in Boston, Johns Hopkins Hospital in Baltimore, the University of Pennsylvania Health System in Philadelphia and Vanderbilt University Medical Center in Nashville have conducted small, preliminary studies of patients transplanted with infected kidneys, hearts and lungs.

There’s no data on patients over the long term, but doctors say larger, more robust studies are in the works.

Alexandra Glazier is CEO of New England Donor Services, which coordinates organ donation in six states.

“We’re seeing a collision of two public health crises come together,” she said. “The fact that there can be some life-saving legacy out of a pretty horrific public health crisis is a reality.”

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.”

But Vanderbilt doctors explained that antiviral drugs cleared the virus in nearly all patients. And Licht also knew that 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 with no signs of the virus in her blood.

“I don’t take much for granted now that I have a second chance of living,” Licht said.

Vanderbilt has transplanted about 50 hepatitis C-infected hearts into people without the virus.

Researchers have published the results of 13 patients, 12 or whom never had hepatitis C.

Nine developed traces of the virus following transplant, and eight of those patients were cleared of the virus after receiving medication.

The other patient died of a pulmonary embolism.

Vanderbilt has made the transplants a standard part of its practice, according to Ashish Shah, the chairman of the hospital’s department of cardiac surgery.

“We wanted to change the clinical practice because patients were dying,” Shah said.

Vanderbilt limits the transplants to patients who can’t get a heart in time though the conventional wait list, or those whose mechanical pumps are failing.

Shah describes the growing comfort with infected organs as a part of an evolution.

“In the history of transplantation, our concerns about donor lifestyle have been a little over-exaggerated,” Shah said. “Smokers, alcohol or cocaine use … It turns out they are still better than the hearts we are taking out. It is not much or a risk factor for long-term results.”

Shah says his practice is still monitoring patients for signs of heart disease.

Desai, of Johns Hopkins, studied 10 organ recipients who were treated and cleared of hepatitis C. The study was sponsored by the drug company Merck & Co. and tested that company’s Hepatitis C drug, Zepatier.

Desai is optimistic that infected organs will allow more patients to get transplants. But he said the cost of medications is a challenge.

When Gilead Sciences obtained Food and Drug Administration approval to market is 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 antivarals.

Other hepatitis C drugs, such as AbbVie’s Viekira Pak and Merck’s Zepatier, are similarly costly.

Most transplants are covered by government programs such as Medicare and Medicaid. Desai said it’s too early to tell whether private insurers will be willing to pay for transplants of hepatitis C organs.

Blackshear says he wasn’t worried about the cost of the antiviral drugs. He just wanted a new kidney – and a longer life.

He feels reinvigorated in his job as an advertisement coordinator for a small chain of West Texas grocers.

“I’m doing so much better now,” Blackshear said. “There are a lot of people waiting for kidneys. Who would have thought I’d get a kidney in two weeks?”

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