Use of Hepatitis C–Infected Deceased Donors in Liver Transplantation

The use of hepatitis C–infected (HCV⁺) liver donors for HCV⁺ transplant recipients was previously controversial, but mounting evidence now supports this practice. HCV-related cirrhosis accounts for 45% of the liver transplants in the United States; however, these transplant recipients have worse transplant outcomes when compared to non–HCV infected (HCV^-) recipients. The optimal utility of the donor graft is therefore decreased with transplantation of HCV⁺ recipients because the largest percentage of organs are transplanted into patients with inferior survival outcomes. Increased use of HCV⁺ livers, which can only be transplanted into HCV⁺ recipients, provides additional transplant liver allografts directly targeted to the recipient population at greatest need. As HCV⁺ recipients are transplanted with previously unusable organs, more HCV^- donor livers are available for the HCV^- recipient population, thereby increasing the utility of HCV^- grafts. Therefore, increased use of HCV⁺ donors results in increased utility of all available liver allografts and a shorter waitlist time to transplant, because the total number of available organs is increased. This review discusses the use of HCV⁺ donor livers in transplantation, including donor organ evaluation, hepatitis C in liver transplantation, a review of the available literature, and the future direction of HCV⁺ donors in transplantation.