Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ TRENDS ++ The demand for liver transplantation continues to expand and to outstrip the number of organs available for transplantation. As a result, there is an increasing use of livers from donors with a wide range of risks, including an increased risk of infectious disease transmission. Discard rates are higher for these donors despite the fact they may be high-quality donors. One risk of using a broader array of donors is that there is approximately 0.2% transmissions of infections from donors to recipients.1 +++ RISK ASSESMENT ++ To reduce the risk of disease transmission through liver transplantation, donors are generally screened for the following categories: Behavioral assessment Screening donor testing (Table 47-2) Physical examination by both the organ procurement organization and the transplant surgical team ++Table Graphic Jump LocationTABLE 47-2OPTN-Defined Increased Risk Donors1-4View Table||Download (.pdf) TABLE 47-2 OPTN-Defined Increased Risk Donors1-4 HIV ELISA HIV NAT HCV ELISA HCV NAT Window period 22 days 9 days 66 days 7 days Men who have sex with men 8.3 3.4 36.0 3.8 IV drug users 12.9 5.3 350.0 37.8 Hemophiliacs 0.05 0.02 0.46 0.05 Person who had sex in exchange for money or drugs 2.9 1.2 107.8 11.5 Partner with a person who had sex in exchange for money or drugs 2.7 1.1 126.2 13.5 Blood product exposure 1.3 0.5 22.0 2.3 Incarcelation 1.5 0.6 68.6 7.3 +++ Behavioral Categories ++ A careful review of the donor’s medical and social history to identify evidence of preexisting transmissible conditions or risk factors for transmissible infections. Individuals within any of the categories listed in Table 47-1 are considered high-risk donors.2 Defined by the Organ Procurement and Transplantation Network (OPTN) with U.S. Public Health Service guidelines. OPTN-defined Increased Risk Donors The major screening donor testing methods available (Table 47-2) are: Enzyme-linked immunosorbent assay (ELISA) for antibody testing Nucleic acid testing (NAT) The use of NAT should be considered when evaluating seronegative donors with high-risk behavioral characteristics. NAT is not required by the OPTN and sometimes may not available in organ procurement organizations (OPOs). The cost of NAT is variable among OPOs. Median cost is US$460 in addition to the cost of transportation of the sample to the laboratory.3 Routine use of NAT may lead to unnecessary loss of uninfected organs because of false-positives.4 The false-positive rate from initially reactive false positive using NAT in tissue and blood donors is estimated to be 0.1% to 0.85%.3 The window period is the time between acquisition of the infection and serologic detectability.4 NAT narrows the window periods in HIV, hepatitis C virus (HCV), and hepatitis B virus (HBV) when compared to serology alone (Table 47-4).5 HIV: 12 days reduction HCV: 30 days reduction HBV: 12 days reduction Seropositive/NAT-negative donors can result from either: False-positive serology Naturally cleared ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.