Introduction: Use of HCV-viremic donor organs (D+) for transplant into HCV-seronegative recipients (R-) has been shown to be safe and equally effective as using HCV-seronegative donor organs since 2016. Therefore, we sought to evaluate changes in frequency of transplant candidates being listed as willing to consider offers of HCV-viremic donor organs (“HCV offer interest”) from 2015-2021 as a measure of greater openness to HCV D+/R- transplants among transplant candidates and centers.

Methods: We identified all waitlist candidates 2015-2021 listed for kidney, liver, heart, or lung transplantation in the United States using the Scientific Registry of Transplant Recipients. Waitlist candidate HCV serostatus was not available, but the proportion of waitlist additions for HCV-related disease in the United States is declining. We compared patient and center characteristics using Chi-square and McNemar tests, by HCV offer interest, for pediatric (<18 years old) and adult transplant candidates.

Results: We identified 392,515 waitlist candidates (269,770 kidney, 69,728 liver, 32,418 heart, 20,599 lung), including 377,375 adult and 15,140 pediatric candidates. Overall, 33.8% of adult and 4.1% of pediatric candidates were recorded as interested in HCV D+ organ offers (p<0.001, Table 1). HCV offer interest varied by organ type among both adult (30.3% kidney vs. 42.3% liver vs. 45.0% heart vs. 35.3% lung, p<0.001) and pediatric candidates (2.0% kidney vs. 3.0% liver vs. 7.3% heart vs. 12.9% lung, p<0.001). All organ types showed increased HCV offer interest over time (Figure 2). The percentage of transplant centers who had at least one pediatric candidate listed as interested in HCV D+ offers had a trend toward an increased from 2015 to 2021 for kidney (4.5% vs. 12.1%, p=0.07), liver (3.6% vs. 9.4%, p=0.06), heart (7.1% vs. 16.1%, p=0.1), and lung candidates (12.0% vs. 33.3%, p=0.5). The percentage of transplant centers who had at least one adult candidate listed as interested in HCV D+ organ offers remained stable from 2015 to 2021 for kidney (74.2% vs. 77.4%, p=0.8) and liver (92.4% vs. 93.4%, p>0.9) candidates and increased for heart (48.6% vs. 72.1%, p<0.001) and lung (31.8% vs. 58.9%, p<0.001) candidates.

Conclusion: Willingness to consider HCV-viremic donor organs has increased since 2015 at the patient and center levels among pediatric and adult candidates, especially pediatric lung transplant candidates. This reflects the increasing recognition of the safety and efficacy of HCV-viremic organ transplants into HCV-seronegative recipients. However, a substantial percentage of transplant centers still have no candidates listed as willing to consider HCV-viremic donor offers, possibly indicating a lack of comfort with HCV D+/R- transplants. We must address this discomfort with educational initiatives to ensure this valuable organ pool is available to as many waitlist candidates as possible.