Augmented risk donors

An augmented risk donor is someone who had certain behaviours during their life that put them at higher risk of contracting and transmitting certain diseases.

All donors are thoroughly screened for infectious diseases before transplant. However, there's a brief window period where someone may have contracted an infection in the days before their death that doesn't yet appear on tests. These infections include:

• HIV
• Hepatitis B
• Hepatitis C

There are not enough donated organs in Ireland for everybody on the active list to receive a transplant. There is also evidence that having a transplant from an augmented risk donor doesn't impact patient outcomes.

Therefore, Ireland and other international transplant centres offer this as a way to increase the amount of organs available.

All organ transplants in Ireland are screened to minimise the risk of transmitting any disease from a donor. This screening and testing is similar to what is done for blood donation. This includes:

• A thorough review of the donor’s past medical and social history
• A physical exam of the donor and donor organs, checking for signs of intravenous (IV) drug use, evidence of infections and any other potential sign of risk
• Screening of the blood for infection

Limitations

Although organ donors are thoroughly screened and tested, there are still limitations.

• We don’t have screening tests for every infection. For example, right now we don't have a way to test for tuberculosis.
• Testing is not 100% accurate. Although it’s rare, sometimes a test will come back negative even though the person has an infection. This is most common when an infection first happens, because it takes time for the body’s immune response to develop. The time when we can’t detect these early infections is called the 'window period'.
• Our risk assessment relies on a person other than the donor telling us a history about the donor. They may not know everything about the donor.

There have been several studies in the US and Canada looking at the results of transplanting organs from augmented risk donors.

The overall outcomes were the same for the patients who received organs from augmented risk donors as those for patients who received organs from non-augmented risk donors.

The increased risk of infection from the donor does not affect how well the organ will work. In fact, on average, augmented risk donors tend to be of younger age with better organ function.

Risk of undetected infection

When lungs come available, we complete tests that help us determine if there is risk of transmitting infection. However, some tests are only available during normal working hours. If a donation comes available outside of hours, we may only be able to complete certain tests.

Risk of transmission if all available tests are performed:

• HIV: 1 in 2,500,000
• Hep B: 1 in 334,000
• Hep C: 1 in 334,000

Risk of transmission if only antibody and antigen tests performed:

• HIV: 1 in 1,250,000
• Hep B: 1 in 182,000
• Hep C: 1 in 141,000

Even with limitations to testing, the risk of disease transmission is extremely low.

Risk of passing on infection

There is an extremely small risk of passing infection on to your family. Even so, we'll ask you to take extra precaution until we can confirm you are infection free. This is usually 3 months after transplant.

Avoid sharing infected blood or bodily fluids with your family by:

• Not sharing your toothbrush
• Not sharing a razor
• Using a barrier contraception like condoms during sex

Before joining the active list, you’ll be asked whether you consent to receiving an augmented risk donor organ at the time of transplant. You’ll be asked again if an organ comes available, and will need to give consent ahead of surgery.

If you have abnormalities in your liver screening tests during the assessment or while you're on the active list, you may not be able to receive an augmented risk donation.

It is your choice whether you choose to receive an organ transplant from an augmented risk donor. If you prefer not to accept an organ from such a donor, it does not affect your status on the transplant waiting list. You will continue to be considered for all appropriate donor offers according to the standard criteria.

Having a transplant from an augmented risk donor does not change your treatment after transplant. However, you will be tested periodically for new infections, and treatment will be started as needed.