Other The Transplant Surgeon Needed a New Heart—Even if It Had Hepatitis C

[Lawpy]

The Transplant Surgeon Needed a New Heart—Even if It Had Hepatitis C (Outline)

Curious to know what you think. Perhaps @DrSnips @IMreshopeful @ThoracicGuy can provide some insights

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[DrSnips]

It's an interesting topic for sure -- knowingly transplanting an infected organ when we have have treatment / cure for the infection. I don't really see a problem with it as long as there is informed consent regarding the infection that will be contracted. I recall in residency I spent some time in renal transplant clinic, and the transplant nephrologist would offer to place people on a shorter wait list for "high-risk" kidneys. These were kidneys from folks with HCV or even HIV, and you might be able to get one in 20% of the wait time it would take to get a healthy kidney from a healthy donor. Because long-term HD has mortality above that of transplant, such transplants might be the lesser of two evils for patients. Same thing goes I would imagine for patients on VAD or similar who are awaiting heart transplant.

 

[ThoracicGuy]

It's an interesting topic for sure -- knowingly transplanting an infected organ when we have have treatment / cure for the infection. I don't really see a problem with it as long as there is informed consent regarding the infection that will be contracted. I recall in residency I spent some time in renal transplant clinic, and the transplant nephrologist would offer to place people on a shorter wait list for "high-risk" kidneys. These were kidneys from folks with HCV or even HIV, and you might be able to get one in 20% of the wait time it would take to get a healthy kidney from a healthy donor. Because long-term HD has mortality above that of transplant, such transplants might be the lesser of two evils for patients. Same thing goes I would imagine for patients on VAD or similar who are awaiting heart transplant.

Not sure I'd ever take an HIV organ. The potential to cure HCV makes that an interesting option.

 

[DrSnips]

Not sure I'd ever take an HIV organ. The potential to cure HCV makes that an interesting option.

I hear you. Still, if you were at a point where you can't survive on VAD much longer, and the potential of getting an HIV positive heart came up .. HIV isn't curable, but it is much more treatable than end-stage heart failure. That said, I would much rather get the HCV positive one like you said and just cure it afterward.

 

[IMreshopeful]

Thanks for asking my opinion! I’m just a fellow and not an expert but my thought is that the use of these “high risk” organs is controversial but depends on the appropriate situation.

Would you take the organ from a young brain dead guy with IVDA history with the possibility of or a known HCV/HIV infection? Well to me the way I think about it is from a heart transplant perspective is that it really depends on what your risk is long term. The heart failure patient with INTERMACS 2-3 profile and stage D HF who has increased risk and inotropes dependent, with an astronomical mortality, who is already in their 50s-60s may be willing to take that chance if it means that they might contract HCV infection - something potentially curable - but it will give them 15-20 more years of high quality life - then I think it would be worth it. For the guy with a destination therapy LVAD who could live for at least a decade or more with a durable VAD and a good quality of life? Perhaps less worth it even with having to take blood thinners, get checkups, carrying a battery, etc.

HIV I’m less enthused about but I suppose it’s now a chronic disease with antiretroviral therapy. I have seen a couple folks with HIV cardiomyopathy get hearts and do pretty well. I suppose it could work fine the other at around. Also end stage heart failure is a horrific disease - HIV is extremely manageable by comparison.

Its a great story and good food for thought

 

[cardsguy2017]

Hearts are a scarce commodity and anything to expand their availability will certainly be investigated. This particular case seems unique because it almost seems like this doc, who knows what he's in for, is somewhat of a guinea pig under the close watchful eye of his home institution. I'm not sure if we're at a point to confidently do this on the average patient regularly. Really the bigger issue imo is the public reporting and outcomes data that goes on, hospitals are less inclined to take risky patients or try new things for fear of getting penalized. Personally, I wouldn't mind seeing outcomes and data kept private amongst institutions with a higher level of collaboration between each other to ensure the best level of care and latest advancements are being utilized, while pushing the field forward without fear of retribution or penalty.