Epidemic that claims more than 100 lives a day helps save others through organ transplants

In a twist of irony, the same opioid epidemic that has claimed the lives of thousands of young people is saving the lives of others in the United States. 

The program allows transplant centers to transplant certain organs from hepatitis C-positive donors into patients on the waiting list for heart, lung, kidney, liver and pancreas transplantation.

As South Carolina’s only transplant center, MUSC Health has embraced the program, performing 30 successful transplants in the last year and treating patients for hepatitis C within just weeks after the surgery. 

Derek DuBay, M.D., professor of surgery at the Medical University of South Carolina and director of the Division of Transplant Surgery at MUSC Health, said the practice is safe, effective and lifesaving, although he admits to some skepticism when the national program was in its experimental stages several years ago.  

“It took large, carefully designed studies to open people’s eyes to the reality that the practice is not hurting patients but actually helping them,” DuBay said. “It is a very efficacious treatment, and hepatitis C is 99% curable with antiviral medication.”

Since 2013, the Food and Drug Administration has approved multiple direct-acting antiviral agents that have shown high hepatitis C cure rates with minimal side effects, making the once difficult-to-manage disease easily treatable. 

 

The number of organ donors has increased significantly as a result of the opioid epidemic, DuBay said, and about one-third of the increase is from donors with hepatitis C, which is spread through blood-to-blood contact.  

Moreover, these organs are high quality, much higher, in most instances, than organs from non-opioid users, DuBay added. 

“These people have died young, and they otherwise have perfect organs and haven’t had years or decades for the hepatitis C to injure their livers.”

Out of the 440 heart, lung, liver, kidney and pancreas transplants performed at MUSC in 2019, DuBay and his team transplanted 21 kidneys, five hearts and four livers from hepatitis C-positive donors. Of those 30, one patient failed first-line therapy and was immediately and successfully treated with a second-line therapy, DuBay explained, neither of which interfered with transplant immunosuppressive medications. 

“Those 30 transplants represent a 7.5% increase in lives saved in South Carolina – people who might not have gotten a transplant otherwise.” 

Still, the program is not for everyone. “This is an option for many but not all,” he said. The minimum age for organ transplantation from a hepatitis C donor is 55 for a kidney and 50 for a liver. Patients must have a high degree of health literacy, understand what they are saying “yes” to and be resourceful enough to comply fully with their treatments. 

The risk/benefit profile must favor the patient. DuBay tells potential patients that agreeing to accept an organ from a hepatitis C donor can shave years off the wait time for an organ, particularly a kidney. He tells them that they will unequivocally contract hepatitis C, which often has no symptoms. 

“I tell them that they will begin a 12-week medication regimen within two to three weeks after their surgeries, and that, if they are compliant and follow their treatment plans, they’ll have an almost 100% chance of being cured and moving on with their lives.” 

MUSC Health also employs a robust pathway in which pharmacists and transplant infectious disease physicians follow these patients through their recoveries, monitoring and testing them at regular intervals for their responses to the virus. During regularly scheduled transplant follow-up visits, their hepatitis C levels are measured three times: at the initiation of therapy, after four weeks of therapy to confirm treatment response and at 12 weeks after the completion of therapy to confirm the virus was treated and cured.  

“For these patients, accepting a hepatitis C positive organ gives them the chance to resume a full life,” Dubay said. “For the families and loved ones of the donors, it allows them to make something good out of a tragic situation.”