Another issue that has emerged is the use of donor organs, including livers, kidneys, hearts and lungs, from HCV-positive donors, which were previously used only in HCV viraemic recipients. Now, and with appropriate consent, HCV viraemic donor livers have been used in HCV-negative recipients in Australia. This strategy has the potential to increase donor organ availability and reduce waiting list times. International experience has shown that HCV-positive donor kidneys, hearts and lungs can also be successfully transplanted into HCV-negative recipients.
When an anti-HCV-positive/HCV RNA-positive donor is used, HCV infection will be transmitted and should be treated with DAAs in the early post-transplant period. Deferring antiviral therapy increases the risk of symptomatic acute hepatitis C infection; cases of FCH have been reported. This is an evolving and complicated area.
Transmission from anti-HCV-positive/HCV RNA-negative donors is extremely rare and, where reported, probably reflects acute infection in high-risk donors.