Local and regional variability in utilization and allocation of hepatitis C virus-infected hearts for transplantation.

With the advent of direct-acting antiviral agents, there has been a rapid rise in hepatitis C virus-infected (HCV+) heart transplantation. We aimed to understand local and regional differences in utilization and allocation of HCV+ hearts. Using United Network for Organ Sharing (UNOS) de-identified data from January 1, 2016 to September 30, 2019 we compared trends in the utilization rates (hearts transplanted/donors recovered) of HCV-uninfected (HCV-) to those of HCV+ nonviremic (HCV-NV) and viremic (HCV-V) hearts nationally and by UNOS region. We also evaluated allocation rates (hearts successfully allocated/donors recovered) by organ procurement organization (OPO). We found that (1) in 2019, national utilization rates for HCV-NV and HCV-V hearts were the same as HCV- hearts (27.6% for HCV-NV, 30.9 for HCV-V, and 31.7% for HCV-, P = .277); (2) utilization rates of HCV-NV hearts were low in regions 3 and 4 and of HCV-V hearts in regions 3, 4, and 8 even in the contemporary period since 2018; and (3) there was marked variability in allocation of HCV+ hearts at the OPO level even within the same UNOS region. We conclude that despite national strides in the utilization of HCV+ hearts for transplantation, more aggressive allocation of HCV+ hearts at the OPO level may still significantly affect the organ shortage.

An Adapted Process and Organ Procurement Perspective on Heart Retransplantation for a Healthy Heart's Third Life.

As organ procurement organizations nationwide see an increased opportunity to retransplant already transplanted hearts, we would like to share the overview and process of our 2 successful cases. Heart retransplantation increased our cardiac placement rates by 2.64% and 2% in 2015 and 2019, respectively. Spread across a nation that sees over 3500 heart placements annually, a 2% increase would be substantial. Since 2009, our cases stand as the only documented heart retransplantations in the United States. However, United Network for Organ Sharing data shows that potential exists. From a facilitation perspective, we have developed a protocol to ease the matching process. From a surgical perspective, these cases had no complications and saved 2 lives, with each heart now beating in a third person. We hope that by sharing our process and success, we can familiarize fellow organ procurement organizations and transplant communities with this viable opportunity.

Improving Speed and Security When Sharing Protected Health Information of Deceased Organ Donors.

Because extensive data from medical records are gathered by organ procurement teams, the process of data transfer between sites created a data security risk. This includes the use of fax machines, courier services, and employees' vehicles. Even health records transmitted over public Wi-Fi become at risk for a data breach. The Plan-Do-Study-Act method for performance improvement was used to address this time-consuming and labor-intensive process. A secured virtual private network from within the donor hospital site setting was developed to improve the transfer of images and data. The goal was to improve the process and increase data security. Once the new network was in place, the process steps decreased and eliminated data vulnerability. Average process time decreased by approximately 1 hour. Organs procured increased from pre (expected 3, observed 2) to post (expected 3, observed 5) implementation of the new process.