Even for people who have been waiting years for a new kidney, this is still not a choice easily made.
Stay on dialysis longer or accept a kidney from a deceased donor with hepatitis C.
On the one hand, patients on the kidney transplant waiting list typically undergo dialysis three or more days a week for hours each time to clear their blood of toxins.
The average wait time for a kidney is three to five years and even longer in some parts of the United States.
Another option — receiving a kidney carrying the hepatitis C virus — means the patient becomes infected. Left untreated, this can become a lifelong disease that damages the liver, in some cases leading to liver failure.
But new, highly effective medications for hepatitis C may make this a much better option — and more palatable for people waiting for a new kidney.
A pilot study at Penn Medicine will attempt to discover exactly how much better.
How the program works
Researchers plan on transplanting kidneys from deceased donors infected with hepatitis C into 10 people on the kidney transplant waiting list who do not have the virus.
After the transplant, patients will be treated with an extended course of Zepatier, one of the new hepatitis C medications.
This drug — along with others like Sovaldi and Harvoni — have radically changed how hepatitis C is treated.
“Our initial treatments for hepatitis C ranged from nothing to some very rudimentary drugs that had a lot of side effects that were relatively ineffective — to a variety of drugs in the last few years that are almost 100 percent effective in curing the disease.” Dr. Jonathan Bromberg, told Healthline.
Bromberg, who is not involved in the study, is a professor of surgery and of microbiology and immunology at the University of Maryland School of Medicine, and division head of transplant surgery at the University of Maryland Medical Center.
The first patient in the new study, a woman from Pennsylvania, was treated for hepatitis C after her transplant. Doctors announced in September that there are now no signs of the virus in her blood.
The new drugs, though, are not perfect. The one used in the Penn Medicine study has a 95 percent success rate in the general population.
That means some people who receive a hepatitis C positive kidney will still have the virus even after treatment.
Patients are informed of this risk before they agree to the transplant, allowing them to weigh the risks against the benefits.
Increasing available kidneys
Hepatitis C is not the only disease that’s on transplant surgeons’ radar.
“In transplantation we’re always very worried about transmitting an infectious disease from a donor to a recipient,” said Bromberg.
Thirty years ago, doctors were mostly concerned about the transfer of bacterial diseases to recipients with weakened immune systems — a result of drugs given to prevent organ rejection.
Antibiotics have reduced this risk, but other diseases have filled in the gap, such as hepatitis B and C and HIV.
The new hepatitis C drug may reopen a closed pool of organ donors.
Currently, kidneys from people infected with hepatitis C are only donated to people who already have the virus. That means that many infected kidneys that become available are never transplanted.
According to the Centers for Disease Control and Prevention (CDC), up to 3.9 million Americans are living with chronic hepatitis C. A 2012 study found that more than half of these people are unaware that they are infected.
Every organ, not just kidneys, is routinely checked beforehand to rule out infections — and to make sure they are working properly.
This is of special concern when dealing with organs infected with hepatitis C.
“When you have hepatitis and you have a lot of damage to the liver, there tends to be secondary damage to other organs, including the heart and lungs and kidneys and pancreas,” said Bromberg
The Penn Medicine researchers estimate that if this approach proves safe and effective, at least 500 more kidneys could be available for transplantation each year.
Paying for a kidney?
This would help, but more than 100,000 Americans are now waiting for a kidney transplant, according to the National Kidney Foundation.
For some, that makes using kidneys from deceased donors with hepatitis C only a short-term solution.
“Every time I read articles about bending over backward to figure out a way to make what would seem like sub-optimal organs acceptable, I think if we would just at least look into the option of rewarding donors, we’d get healthier kidneys because we’d have a whole pool of the nation,” Dr. Sally Satel, author of “When Altruism Isn’t Enough: The Case for Compensating Kidney Donors,” told Healthline.
Right now, buying or selling organs for “valuable consideration” is illegal in the United States. A new bill introduced in Congress earlier this year would clarify that some compensation would not fall under that category — such as medical or travel expenses related to the organ donation or lost wages for the donor.
“[The bill] just says it’s not a crime. It doesn’t mandate that anyone do anything,” said Satel. “It would just give permission to an enlightened hospital or medical center that would like to try this.”
Eventually, we may be able to grow new kidneys in the lab, but that technology is decades away. During that time, if there aren’t enough donated kidneys to go around, thousands of people will be left waiting.
“That’s a lot of misery and death,” said Satel, “so in the interim, I think we should consider rewarding people who are willing to donate in this way.”