The current shortage of liver organs available for transplant has reached near-crisis proportions, resulting in the exploration of other viable options — in particular, livers that had been previously deemed too high risk for transplantation.
In a literature review published in the Journal of Viral Hepatitis, researchers from the University of Cincinnati College of Medicine in Ohio suggest that hepatitis B core antibody (anti-HB c+) organs may be a safe and ethical transplant option in an era where increased medical knowledge has enabled greater treatment for hepatitis.
Use of anti-HB c+ donor organs creates relatively valid safety concerns, particularly among patients who may already be vulnerable to infections. However, because of the increased medical knowledge regarding viral infections, including hepatitis B, the current literature suggests anti-HB c+ donor organs may indeed be safe alternatives to healthy organs if hepatitis B immune globulin prophylaxis is used immediately following transplantation.
There are 4 ethical principles associated with the use of anti-HB c+ organs that should be considered prior to transplant: autonomy, beneficence, nonmaleficence, and justice. In summary, patients receiving organ transplants should be involved in the decision-making process and should be well-informed about their care, fulfilling the ethics aspect of autonomy.
In addition, the use of anti-HB c+ organs reduces potential morbidity and mortality. Whereas anti-HB c+ organs have the potential to cause harm, the available data suggest that the virus can remain dormant with appropriate therapy. Providing these additional options may also result in greater benefit to society at large, fulfilling the justice criteria.
“Posttransplant care has evolved to a point that these organs can be safely used and allow patients with decompensated cirrhosis to return to a state of relative health and benefit the society in general,” the authors wrote. “The next frontier in hepatitis B care is the development of drugs and treatments that provide functional cure of active replicative infection in a high proportion of cases.”
Anwar N, Sherman KE. Transplanting organs from hepatitis B positive donors: Is it safe? Is it ethical? [published online July 3, 2018] J Viral Hepat. doi:10.1111/jvh.12962