Decision-making Among Hepatitis C Virus-negative Transplant Candidates Offered Organs from Donors with HCV Infection.
Decision-making Among Hepatitis C Virus-negative Transplant Candidates Offered Organs from Donors with HCV Infection.
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DOI：
10.1097/txd.0000000000001341
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发表时间：
2022-08
影响因子：
2.3
通讯作者：
中科院分区：
文献类型：
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历史上，许多患有丙型肝炎病毒（HCV）的已故捐赠者的器官被丢弃。高治愈性直接抗病毒（DAA）疗法的出现促使移植中心开展将hcv病毒血症器官（核酸扩增试验阳性）移植到hcv阴性受体的试验，然后进行DAA治疗。然而，影响候选人决定接受hcv病毒血症器官移植的因素尚不清楚。为了探讨患者对hcv病毒血症供者器官移植的看法、影响和经验，我们进行了一项定性半结构化访谈研究，纳入了3项临床试验，调查将hcv病毒血症供者的肺和肾脏移植给hcv阴性受体的安全性和有效性。该研究于2019年6月至2021年3月进行。在44例hcv阴性的器官移植患者中，有3种决策方法：实证分析、风险分析和本能反应。对风险的认识有助于将影响决策的因素概念化。此外，大多数参与者依赖于多种决策方法，要么同时进行，要么依次进行。了解不同的决策模型如何影响患者对hcv病毒供者器官移植的选择，可以促进移植患者和供者之间的共同决策。
Historically, many organs from deceased donors with hepatitis C virus (HCV) were discarded. The advent of highly curative direct-acting antiviral (DAA) therapies motivated transplant centers to conduct trials of transplanting HCV-viremic organs (nucleic acid amplification test positive) into HCV-negative recipients, followed by DAA treatment. However, the factors that influence candidates’ decisions regarding acceptance of transplant with HCV-viremic organs are not well understood. To explore patient-level perceptions, influences, and experiences that inform candidate decision-making regarding transplant with organs from HCV-viremic donors, we conducted a qualitative semistructured interview study embedded within 3 clinical trials investigating the safety and efficacy of transplanting lungs and kidneys from HCV-viremic donors into HCV-negative recipients. The study was conducted from June 2019 to March 2021. Among 44 HCV-negative patients listed for organ transplant who were approached for enrollment in the applicable clinical trial, 3 approaches to decision-making emerged: positivist, risk analyses, and instinctual response. Perceptions of risk contributed to conceptualizations of factors influencing decisions. Moreover, most participants relied on multiple decision-making approaches, either simultaneously or sequentially. Understanding how different decisional models influence patients’ choices regarding transplant with organs from HCV-viremic donors may promote shared decision-making among transplant patients and providers.