Is a history of hepatitis a contraindication for organ donation?

History of Hepatitis and Organ Donation

A history of hepatitis is NOT an absolute contraindication for organ donation, but specific hepatitis markers determine eligibility based on donor-recipient matching and prophylaxis strategies. 1

Hepatitis B Virus (HBV) Donors

HBsAg-Positive Donors

• HBsAg-positive organs are contraindicated for general use but can be considered for specific recipients: 1

  • HBsAg-positive recipients
  • Recipients with protective immunity (anti-HBs ≥10 IU/mL from vaccination or natural infection) 1, 2
  • Life-threatening situations in HBV hyperendemic regions 1

• When HBsAg-positive organs are used, mandatory prophylaxis includes: 1

  • Hepatitis B immunoglobulin (HBIg) plus antiviral agents (tenofovir or entecavir preferred over lamivudine) 1, 3
  • Close post-transplant monitoring for HBV acquisition 1

Anti-HBc Positive ("HBc Alone") Donors

• Anti-HBc positive, HBsAg-negative donors are NOT contraindicated but require antiviral prophylaxis for: 1

  • Liver transplant recipients 1
  • HBV non-immune recipients (those without protective anti-HBs) 1

• The risk of HBV transmission from anti-HBc positive donors is low but real: 4

  • Approximately 70% transmission risk in naive recipients without prophylaxis 3
  • Transmission can be prevented with HBIg plus lamivudine combination therapy 3

Key HBV Donor Considerations

• The American Society of Transplantation explicitly states that HBV-positive donors should be considered for donation to safely expand the organ pool 1
• Transmission risk can be significantly reduced with prophylaxis, and HBV can be readily managed post-transplant 1

Hepatitis C Virus (HCV) Donors

HCV Antibody-Positive Donors

• HCV-positive organs are contraindicated for general use but considered for: 1

  • HCV-positive recipients 1
  • Emergency/life-threatening situations 2

• HCV transmission occurs in 96% of recipients from HCV RNA-positive donors 1

  • However, graft and patient survival at 3.5 years are not significantly different compared to HCV-negative donors 1
  • Survival may diverge after 3-5 years post-transplant 1

HCV-Positive Recipients

• For HCV-positive recipients with end-stage renal disease, transplantation is NOT contraindicated and is actually recommended: 1
  • Survival is better after transplantation than remaining on dialysis 1
  • The HCV status of the donor (positive vs. negative) has no influence on patient and graft survival 1
  • HCV-positive recipients with detectable HCV-RNA can be offered kidneys from HCV-positive donors 1

Modern Era Considerations

• Direct-acting antivirals (DAAs) have dramatically changed HCV management post-transplant: 5
  • High efficacy and good safety profile after transplantation 5
  • Should reduce the number of HCV-positive donors with detectable RNA, limiting transmission risk 5

Hepatitis A and E Viruses

• HAV and HEV infections are NOT a contraindication for transplantation except in cases of acute infection in the donor 1

Critical Screening Requirements

Mandatory Donor Testing

• All potential donors must be screened for: 1
  • HBsAg (hepatitis B surface antigen)
  • Anti-HBc (hepatitis B core antibody)
  • HCV antibody
  • HIV antibody/antigen

Testing Pitfalls to Avoid

• False-negative results may occur due to hemodilution from transfusions; use pre-transfusion samples when possible 2
• Window period infections may be missed by antibody testing alone; nucleic acid testing (NAT) reduces this risk 2
• HCV serology may be negative despite active infection; HCV-RNA monitoring is essential in at-risk recipients 1

Post-Transplant Monitoring Strategy

For Recipients of Hepatitis-Positive Organs

• Essential to define prophylactic strategy based on donor-recipient serology matching 1
• Close laboratory monitoring required for acquired HBV or HCV 1
• Antiviral prophylaxis should be tailored based on specific donor and recipient infection status 2

Clinical Bottom Line

The key principle is risk-stratified matching: organs from hepatitis-positive donors can be safely used when matched to appropriate recipients (those already infected or with protective immunity) with proper prophylaxis and monitoring protocols. 1 This approach maximizes organ utilization while minimizing transmission risk and adverse outcomes. 1