Background: Organ donor referrals may be declined when social or medical history suggests increased risk of blood borne virus (BBV) transmission, although this information can be limited. Inaccurate risk assessments can lead to either missed opportunities for donation, or transmission of BBV to recipients.
We aimed to identify potential missed opportunities, when referrals were declined due to perceived BBV risk, and BBV transmissions via transplantation.
Methods: We used the New South Wales (NSW) Biovigilance Public Health Register, SAFEBOD. This register linked donor referrals in NSW to administrative health databases, including hospital admissions data, notifiable conditions information management system and the death register. For missed opportunities, we examined BBV diagnoses in linked health data for donor referrals (2010-2015) who did not donate due to perceived increased viral risk for HIV, Hepatitis B (HBV) and Hepatitis C (HCV); this included those with active or past infection (based on serology or medical report), or high risk behaviour at referral. For transmissions, we examined donor-recipient pairs 2000-2015 for new BBV diagnoses in linked-health data within 12 months after transplant, and classified transmissions using a standardised algorithm (Green, 2015).
Results: Of 2,961 persons referred for organ donation in NSW (2010-2015), there were 1,164 persons eligible for donation. 165 persons did not donate due to perceived increased BBV risk (Figure 1), and 33 of these 165 (20%) had no evidence of any BBV infection up to their terminal contact with health services.
In NSW (2000-2015), 2,194 organ donors donated 3,940 organs to 2765 recipients. 2,096 donors had baseline BBV transmission risk and 98 had increased BBV transmission risk. There were 3 proven/probable transmission events (2 HBV, 1 HCV), all from donors with active or past BBV (Figure 2). There were no deaths due to transmissions.
Conclusions: BBV risk assessments are largely accurate with few transmissions but up to 20% rejected referrals may be missed opportunities. Routinely collected administrative health data may provide a useful additional information source to aid decision-making.
1. Green M., et al, Donor-derived transmission events in 2013: a report of the Organ Procurement Transplant Network Ad Hoc Disease Transmission Advisory Committee, Transplantation, 2015, 99(2):282-7