Should Hepatitis C Donors Be Used in Naïve Urgent Status Patients on the Heart Transplant Waitlist?

  • Chetan B. PatelEmail author
  • Adam D. DeVore
Invited Commentary


Purpose of Review

The aim of this commentary is to review contemporary data on the use of hearts from hepatitis C positive donors.

Recent Findings

There continues to be a critical shortage of suitable heart donors available for patients with advanced heart failure requiring transplantation. Historically, donors with chronic hepatitis C virus were not utilized for heart transplantation due to concern about poor post-transplant outcomes. This was due, in part, to concerns about successfully treating chronic hepatitis C after transmitting the infection from donor to recipient. The availability of direct-acting anti-viral therapies is changing this paradigm. These therapies are generally well-tolerated and have excellent rates of viral clearance.


We believe that heart donors with chronic hepatitis C should be routinely utilized for patients listed for urgent heart transplantation.


Heart transplantation Hepatitis C Organ donation Patient selection Advanced heart failure 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Colvin M, Smith JM, Skeans MA, Edwards LB, Uccellini K, Snyder JJ, Israni AK and Kasiske BL. OPTN/SRTR 2015 annual data report: heart. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg 2017;17 Suppl 1:286–356.Google Scholar
  2. 2.
    Samsky MD, Patel CB, Owen A, Schulte PJ, Jentzer J, Rosenberg PB, et al. Ten-year experience with extended criteria cardiac transplantation. Circ Heart Fail. 2013;6:1230–8.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Chen CW, Sprys MH, Gaffey AC, Chung JJ, Margulies KB, Acker MA, et al. Low ejection fraction in donor hearts is not directly associated with increased recipient mortality. J Heart Lung Transplant. 2017;36:611–5.PubMedCrossRefGoogle Scholar
  4. 4.
    Gaffey AC, Chen CW, Chung JJ, Han J, Owens A, Acker MA, et al. Extended distance cardiac allograft can successfully be utilized without impacting long-term survival. J Heart Lung Transplant. 2017;36:968–72.PubMedCrossRefGoogle Scholar
  5. 5.
    Cosio Carmena MD, Gomez Bueno M, Almenar L, Delgado JF, Arizon JM, Gonzalez Vilchez F, et al. Primary graft failure after heart transplantation: characteristics in a contemporary cohort and performance of the RADIAL risk score. J Heart Lung Transplant. 2013;32:1187–95.PubMedCrossRefGoogle Scholar
  6. 6.
    Nicoara A, Ruffin D, Cooter M, Patel CB, Thompson A, Schroder JN, et al. Primary graft dysfunction after heart transplantation: incidence, trends, and associated risk factors. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg. 2018;18:1461–70.CrossRefGoogle Scholar
  7. 7.
    • Grinstein J, Lourenco LM, Te HS, Renz JF, Jeevanandam V, Uriel N. Accepting hearts from hepatitis C-positive donor: can we expand the donor pool? J Card Fail. 2017;23:762–4 This case report was one of the first to describe the use of ledipasvir-sofosbuvir to successfully treat hepatitis C after a combined heart and liver transplantation. PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Goldberg DS, Abt PL, Blumberg EA, Van Deerlin VM, Levine M, Reddy KR, et al. Trial of transplantation of HCV-infected kidneys into uninfected recipients. N Engl J Med. 2017;376:2394–5.PubMedCrossRefGoogle Scholar
  9. 9.
    • Schlendorf KH, Zalawadiya S, Shah AS, Wigger M, Chung CY, Smith S, et al. Early outcomes using hepatitis C-positive donors for cardiac transplantation in the era of effective direct-acting anti-viral therapies. J Heart Lung Transplant. 2018;37:763–9 This is the largest study to date describing the use of HCV-positive donor hearts for HCV-negative patients followed by direct-acting anti-viral therapies. PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Medicine and Duke Clinical Research Institute, Division of CardiologyDuke University School of MedicineDurhamUSA

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