People with hepatitis C may be organ donors as well as those who do not have this infection, according to a protocol being finalized by the National Transplant Organization. Now only one organ with the virus is used when the patient waiting is at vital risk, and always within a policy of tests applied to heart and liver, especially. But the director of the ONT, Beatriz Domínguez, has confirmed that the restrictions to use organs of these people will be eliminated, and hopes that it does not take much, but does not have a date for it. The main cause of this change is in the success of the new direct-acting antivirals against the hepatitis C virus, explains Domínguez. “These have shown cure rates close to 100%,” he says.
The conditions for disposing of organs of these donors will be the same as in any other case. If until now there was a distinction between person without hepatitis C, person with antibodies (donor with conditions) and person with the virus (non-donor), that distinction will be eliminated.
This will allow the organs to be transplanted even though there is a risk that the recipient will acquire the liver infection, because when it is considered appropriate, they can start treatment against virus C, which is simple (two pills a day), short (two to three months), effective (healing of more than 95%) and that does not interfere with the immunosuppressants that take the receptors of an organ. “That, with the previous treatments of hepatitis based on interferon did not happen,” says Dominguez, since this medication altered the immune system. In addition, neither the time (from six months to a year) nor the efficacy (around 60%) nor the adverse effects (many abandoned it because of the depression and anxiety it caused) advised its use.
Domínguez assures that the experience of the USA in this case has been decisive. “The country has a crisis of opiate addicts,” he explains, “which provides a high number of potential donors for the death of young people,” since they are the most frequent consumers. This has led to the existence in the last five years, from the extensive use of the new treatments against hepatitis C, sufficient scientific knowledge to support this use.
Of course, the effect will not be revolutionary. The ONT calculates that in Spain may increase donations by 5%, which would mean moving from the 5 261 organs transplanted in 2017 (last year with data) to more than 5,500. However, the ONT, which in 2017 reached a rate of 46.9 donors per million inhabitants (the next in the world is Portugal, which has imported the Spanish model, with 32.7), looks for any loopholes to increase cases. In the long term, the benefit will be maintained, calculates the ONT, but because people with hepatitis C will be cured and can donate without restrictions, as explained Marina Berenguer, pathologist at the Hospital de La Fe (Valencia), in April of this year. In addition, Domínguez points to another aspect: “It will give a message of non-discrimination towards people with hepatitis C”.
The president of the National Federation of Patients and Liver Transplants (FNETH), Eva Díaz, agrees on the normalizing aspect of the measure, and believes that it is “an advance”. “If in advance you know that you are going to receive a liver with an illness and you accept it, go ahead,” he says. “It can also happen, in the case of older people, that hepatitis does not develop while they live,” he says.
Daniel Gallego, president of the ALCER Renal Association, agrees to support the project “as long as the affected party is informed and accepted.” Although kidney patients are those with the largest waiting list to receive an organ (about 4,500 people), they are also those who benefit from more transplants (3,269 in 2017), in addition to having other alternatives, such as dialysis. That is why Gallego believes that “there will be few cases of renal donors with hepatitis C.” “Another thing will be in vital organs, like the heart or the liver,” he says. Your acceptance “will depend on each one, on the expectations you have of receiving an organ without hepatitis”. “The advantage of this protocol is that it will be the same for everyone, some will not benefit more from being in a hospital than others, like now,” he adds.
The president of ALCER points out that in the future this initiative could reach people with HIV, who now can not donate either. The difference is that current treatments against this infection do not cure it, but rather control the virus to such a low concentration that it does not pose a risk to health, as long as antivirals are taken throughout life. It could be the case that a person with HIV did not have a virus in the kidney or heart. This possibility has not yet been formally raised, says the director of the ONT, but admits that there have already been debates about it. “In this case where there is more experience is in South Africa, but in transplants in which donor and recipient”