Should hepatitis C-infected kidneys be transplanted in the United States?

Over the past several years, the issue of hepatitis C virus (HCV) infection in renal transplantation has generated considerable interest. With the availability of a test for HCV, some but not all physicians have advocated that all HCV-infected kidneys be discarded. An economic appraisal was carried out to examine 3 theoretical policies of organ allocation for HCV-infected kidneys: (a) discard all infected kidneys, (b) transplant infected kidneys into infected donors only, or (c) transplant regardless of HCV status. Using probabilities, costs, and patient outcomes from the literature/best estimate, a cost-utility analysis was performed. Patients free of infection transplanted with an infected organ were assigned higher treat-ment costs and poorer outcomes compared with all other combinations. Assuming a potential to transplant 8100 kidneys per year, option A was predicted to produce the fewest total quality-adjusted life years (QALYs) and incur the highest costs (largely due to patients left on dialysis). Option B was projected to produce the most QALYs, whereas option C incurred the lowest costs (no need to screen for HCV). The incremental cost utility of option B over C was $13,954 (present value 1990)/QALY. This economic appraisal suggests that transplanting HCV-infected kidneys into infected recipients is superior to a discard policy from both a cost and patient outcome perspective. However, other overriding factors, such as the ethical dilemma of transplanting an infected organ, must be addressed by both physician and patient/public before a consensus can be reached.