Increased risk donor criteria: The time for change is now.
Increased risk donor criteria: The time for change is now.
复制标题
提高风险捐助者标准：现在是改变的时候了。
DOI：
10.1111/ctr.13879
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发表时间：
2020
影响因子：
2.1
通讯作者：
Englesbe,MichaelJ
中科院分区：
文献类型：
--
作者：
Wakam,GlennK;Brown,CraigS;Englesbe,MichaelJ
公共卫生服务局于1994年制定了增加风险献血者（IRD）的指定，并于2013年更新，以确定传播HIV，B型肝炎和丙型肝炎增加的献血者。虽然税务局的指定是善意的，但自实施以来的发展造成了一些问题。检测和治疗的进步极大地改变了这些疾病患者的发病率和轨迹。最近的证据表明，IRD器官与非IRD器官具有等同的移植物和患者存活率，但IRD肾脏的丢弃率比非IRD肾脏高50%。鉴于近20%的器官目前被标记为IRD，IRD指定的累积结果是每年有数百个IRD器官，这些器官对于移植是安全的，并且表现与非IRD器官一样好。有证据表明，IRD的指定在提供者和患者之间产生了负面偏见。公共卫生服务指南目前正在更新，这为移植界提供了一个独特的机会，大力倡导以证据为基础的变革，这将改善所有患者的移植机会。我们给编辑的信简要概述了IRD指定的当前问题，并提出了移植界应该认可的建议。为了增加挽救生命的移植数量，移植界必须重新评估公共卫生服务（PHS）指定的增加风险供体（IRD）器官。尽管存活率相当，但IRD肾脏的丢弃率比非IRD肾脏高50%。1，2虽然关于IRD利用的最全面的研究已经过时，应该使用最近的数据进行重复，但当代OPTN数据显示PHS肾脏的丢弃率在十多年内保持不变，使我们相信这个问题仍然没有得到解决。3卫生和公众服务部目前正在更新PHS准则。现在是倡导变革的时候了，变革将改善这些重要器官的利用。
The Public Health Service designation of increased risk donor (IRD) was created in 1994 and updated in 2013 to identify donors with increased of transmitting HIV, hepatitis B, and hepatitis C. While IRD designation was well intentioned, developments since its implementation have created several problems. Advancements in testing and treatment have dramatically changed the incidence and trajectory of patients with these diseases. The most recent evidence shows that IRD organs have equivalent graft and patient survival to non-IRD organs, but IRD kidneys are discarded at a 50% higher rate than non-IRD kidneys. Given nearly 20% of organs are currently labeled as IRD, the cumulative result of the IRD designation is hundreds of IRD organs, that are safe for transplant and perform as well as non-IRD organs, go unused annually. Evidence has shown IRD designation creates negative bias among both provider and patients. The Public Health Service guidelines are currently in the process of being updated which presents a unique opportunity for the transplant community to strongly advocate for evidence-based changes which will improve access to transplant for all patients. Our letter to the editor briefly outlines the current problems with the IRD designation and proposes recommendations the transplant community should endorse.In an effort to increase the number of life-saving transplants, the transplant community must re-evaluate the Public Health Service (PHS) designation of increased risk donor (IRD) organs. IRD kidneys are discarded at a 50% higher rate than non-IRD kidneys, despite equivalent survival. 1, 2 While the most comprehensive study on IRD utilization is dated and should be repeated using recent data, contemporary OPTN data show the discard rate of PHS kidneys has remained unchanged for over a decade leaving us to believe this issue remains unresolved. 3 The Department of Health and Human Services is currently in the process of updating the PHS guidelines. Now is the time to advocate for change that will improve utilization of these vital organs.