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  • Sep 27, 2018

Barbara Rutkowski, EdD, MSN, CCM - Vice President, Clinical Operations, Advanced Plan for Health and Yvonne Daugherty, VP of Development, Advanced Plan for Health

There are about 99,000 Americans listed for a transplant, some for many years. Unfortunately, about 4,800 die each year while they wait for their transplant. Not everyone is at the top of the transplant list nor do they have the remaining life and / or health to undergo the procedure if the wait is too long.

Expanding the available organ pool can save lives and reduce overall costs in many cases.

There is a relatively new source of organs available from deceased individuals infected with Hepatitis C (HCV-infected). These organs were formerly discarded, but they are now being utilized. These HCV-infected organs are becoming available for transplant in growing volume due to the greatly increased number of tragic deaths in young adults dying from opioid and fentanyl overdoses.

According to the Centers for Communicable Disease Control, some 3.5 million Americans have chronic Hepatitis C.

“With more young adults dying from heroin and fentanyl overdoses, doctors became frustrated when otherwise-healthy organs were tossed out because they were infected with hepatitis C.” USA Today

“New antiviral drugs that promise a cure for the millions of Americans with chronic hepatitis are also benefiting another category of patients: those awaiting organ transplants” According to The Washington Post.

Having a kidney transplant is much less expensive than the $350,000 to $700,000 that health plans pay annually for the total healthcare of individuals on dialysis. More importantly, this development is a lifesaving procedure for many who would not have survived long enough to have a transplant without the availability of these HCV-infected organs. This provides extended life and improved quality of life for more organ recipients, and it is one example of how innovative practice and revolutionary pharmacology have eradicated the HCV infection in infected individuals, making the reality of transplant available to so many more people.

Transplant Success Stories

The University of Pennsylvania has successfully transplanted 20 individuals with hepatitis C-infected kidneys from cadavers since 2016. All of these individuals are now free of hepatitis C, due to treatments that can eradicate some strains of this viral disease.

In 2017, there were 114,000 individuals waiting for an organ transplant. Of 37,795 organs transplanted, some 1,391 tested positive for HCV infection. In 2018, 803 organs tested HCV positive in the first half of the year. The biggest demand is for kidney transplants, followed by liver, heart, pancreas, lung and then intestine transplants. “The average wait time for a non-infected kidney is more than two years, compared to eight months for an HCV-infected kidney.”

In July, 2018, a 70 year old male with one kidney, who was in failing health, agreed to a transplant with an HCV-infected kidney, and was transplanted within two weeks at Banner University Medical Center in Phoenix. For him, waiting five years was not an option.

Vanderbilt has transplanted 44 hepatitis C infected hearts, which is the largest number done by any transplant center to date. According to the Vanderbilt team, it is critical to select quality organs for transplant and to monitor recipients closely because they are immune suppressed due to the anti-rejection medications they take to make the transplant successful. Currently, none of these individuals with transplanted hearts at Vanderbilt is HCV infected.

For both the kidney and heart transplant teams, the protocols are very exacting for selecting a quality organ, educating the recipient, and closely monitoring and treating any infections in the organ recipient with the most effective HCV pharmacologic therapy available. In the case of heart transplantation, the detection and treatment of hepatitis in organ recipients is carefully monitored by a multidisciplinary team. Other transplant centers have carefully studied the Vanderbilt program, because the expansion of available hearts for transplant makes this life-saving surgery available for more critically ill cardiac patients who often die while waiting for a heart transplant.

According to another source addressing HCV-infected heart and lung transplants, the speaker relied on a study of 64 patients, where the organs were transplanted from the 13 donors who were not viremic. All of them had hepatitis C antibodies but did not test positively in nucleic antigen testing (NAT) and did not transmit an active virus to the recipient.

A Shift in Marketplace Thinking

From what we are seeing in the marketplace, it seems that traditionally Hepatitis C organs were given to Hepatitis C positive patients, and those transplants were primarily livers. The thought was that if the liver was positive, they could treat that post-transplant. Now with the new advent of the widely popular and successful Hepatitis C antiviral therapies, more and more plans are supporting the expansion of transplantation of other organs from Hepatitis C donors, and allowing transplants for those who do not have Hepatitis C.

Obviously, approval for the transplants involves looking at each individual case individually for medical necessity, patient condition, organ quality and the best course of action, which includes having the Plan medical director work with the Transplant Medical Director in their reviews. The other critical aspect is performing the transplant at a Center of Excellence which has protocols in place for effectively managing transplant patients who receive an organ from an HCV-infected individual. Organ recipients must consent to receiving the organ from an individual who has tested positive for HCV antibodies and possibly an infection and be educated on what that entails.

Paying for HCV Infected Organs

Newspapers across the land are reporting on the success of transplanting HCV infected organs with information gleaned from a combination of medical journals and professional conferences. The big question now is “what is the utilization review criteria that private insurers are developing?”

The next step is to continue refining protocols so that the procedure is safe and effective in prolonging life without untoward disease and complications. Of course, the other matter is if and what is needed for insurance to cover the cost of these transplants.

Where does your Health Plan stand on paying for this type of transplant?


Contact us if you’d like to learn more about how our Poindexter advanced and predictive analytics platform can deliver the macro to micro-level visibility you need to identify and support those in need of a transplant, as well as those with other predictors of diseases, chronic conditions and co-morbidities in your population.