An inadequate supply of transplantable organs necessitates new approaches to organ availability. Organs from donors considered at “high risk” (CDC 1994) or “increased risk” (U.S. PHS 2013) for transmission of viral infection, as well as donors known to carry hepatitis C virus (HCV), provide an expanded source of organs for transplantation. Our experience at the Massachusetts General Hospital demonstrates that such organs can be used safely. However, the risks associated with such use mandate that the recipients of such organs be carefully monitored for active infection due to HCV as well as HIV and HBV. Given the emphasis on use of electronic medical records, the monitoring system require development of reports that track recipients of increased risk or HCV+ donor organs, documentation of informed consent, and microbiologic testing data. In our hands, use of increased risk donor organs with universal NAT testing and use of HCV NAT+ organs has allowed transplantation in a large group of individuals who would not otherwise have received organs in a timely manner. Use of such organs can be performed safely with appropriate informed consent and rigorous pre- and post-transplant microbiological testing and tracking. Successes to date in the use of such grafts must be accompanied by research into long term outcomes and advanced technologies to further improve transplant safety.
