Decision-making Among Hepatitis C Virus-negative Transplant Candidates Offered Organs from Donors with HCV Infection.
Journal
Transplantation direct
ISSN: 2373-8731
Titre abrégé: Transplant Direct
Pays: United States
ID NLM: 101651609
Informations de publication
Date de publication:
Aug 2022
Aug 2022
Historique:
received:
28
03
2022
accepted:
16
04
2022
entrez:
4
8
2022
pubmed:
5
8
2022
medline:
5
8
2022
Statut:
epublish
Résumé
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.
Sections du résumé
Background
UNASSIGNED
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.
Methods
UNASSIGNED
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.
Results
UNASSIGNED
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.
Conclusions
UNASSIGNED
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.
Identifiants
pubmed: 35923812
doi: 10.1097/TXD.0000000000001341
pmc: PMC9298473
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e1341Subventions
Organisme : NIAID NIH HHS
ID : K24 AI146137
Pays : United States
Informations de copyright
Copyright © 2022 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.
Déclaration de conflit d'intérêts
P.P.R. and D.S.G. received investigator-initiated and collaborative grants from Merck, AbbVie, and Gilead to the University of Pennsylvania in support of trials of transplanting HCV-viremic organs into HCV-negative recipients followed by antiviral treatment. P.P.R., D.S.G., J.M.D., M.M.C., and C.B. received investigator-initiated grant funding from Merck to the University of Pennsylvania in support of a trial of transplanting HCV-viremic lungs into HCV-negative recipients followed by antiviral treatment. The other authors declare no conflicts of interest.
Références
AJOB Empir Bioeth. 2020 Jan-Mar;11(1):40-52
pubmed: 31618112
Soc Sci Med. 2016 Apr;155:43-50
pubmed: 26986241
BMJ. 1998 Oct 31;317(7167):1209-12
pubmed: 9794861
Hepatology. 2020 Feb;71(2):686-721
pubmed: 31816111
Kidney Int. 2021 Dec;100(6):1190-1198
pubmed: 34237327
Ann Intern Med. 2017 May 02;166(9):637-648
pubmed: 28319996
Am J Kidney Dis. 2021 May;77(5):739-747.e1
pubmed: 33333148
Transplantation. 2018 Mar;102(3):454-460
pubmed: 28976413
Prog Transplant. 2020 Dec;30(4):368-371
pubmed: 32959728
J Heart Lung Transplant. 2018 May;37(5):564-567
pubmed: 29395752
Am J Transplant. 2017 Nov;17(11):2790-2802
pubmed: 28556422
Transplantation. 2018 Apr;102(4):e163-e170
pubmed: 29346260
Am J Transplant. 2020 May;20(5):1463-1464
pubmed: 31965724
Lancet Gastroenterol Hepatol. 2020 Jul;5(7):649-657
pubmed: 32389183
Ann Intern Med. 2018 May 15;168(10):702-711
pubmed: 29710288
J Immunol. 2015 Feb 1;194(3):1334-46
pubmed: 25527788
BMC Med Res Methodol. 2013 Sep 18;13:117
pubmed: 24047204
Ann Intern Med. 2018 Apr 17;168(8):533-540
pubmed: 29507971
N Engl J Med. 2019 Apr 25;380(17):1606-1617
pubmed: 30946553
BMJ Open. 2013 Jun 20;3(6):
pubmed: 23794542
J Am Soc Nephrol. 2020 Nov;31(11):2678-2687
pubmed: 32843477
PLoS One. 2021 Oct 5;16(10):e0258143
pubmed: 34610030
N Engl J Med. 2017 Jun 15;376(24):2394-2395
pubmed: 28459186
Clin Trials. 2011 Oct;8(5):616-23
pubmed: 21813584
Transpl Infect Dis. 2019 Oct;21(5):e13146
pubmed: 31306562
Semin Dial. 2019 Mar;32(2):179-186
pubmed: 30475409
Am J Transplant. 2020 Feb;20(2):474-492
pubmed: 31550422
Hastings Cent Rep. 2009 Jul-Aug;39(4):26-36
pubmed: 19711632
Univ PA Law Rev. 1974 Dec;123(2):340-438
pubmed: 11664341
Am J Transplant. 2013 Jun;13(6):1390-9
pubmed: 23648238
Hepatology. 2021 Jun;73(6):2110-2123
pubmed: 32926749
Transpl Infect Dis. 2021 Jun;23(3):e13540
pubmed: 33259125
Int J Qual Health Care. 2007 Dec;19(6):349-57
pubmed: 17872937
Liver Transpl. 2014 Sep;20(9):1072-80
pubmed: 24863055
Clin Transplant. 2017 Oct;31(10):
pubmed: 28712111
Am J Transplant. 2017 Nov;17(11):2755-2756
pubmed: 28632974
Am J Transplant. 2020 Jan;20 Suppl s1:542-568
pubmed: 31898411
Transpl Infect Dis. 2021 Feb;23(1):e13449
pubmed: 32810315
Am J Transplant. 2016 Oct;16(10):2836-2841
pubmed: 27438538
J Am Soc Nephrol. 2019 Oct;30(10):1939-1951
pubmed: 31515244
MMWR Morb Mortal Wkly Rep. 2019 Jan 25;68(3):61-66
pubmed: 30677008
J Viral Hepat. 2020 Nov;27(11):1179-1189
pubmed: 32500618
Am J Transplant. 2013 May;13(5):1149-58
pubmed: 23489435
Open Forum Infect Dis. 2018 Jun 07;5(6):ofy076
pubmed: 29977955
Contemp Clin Trials. 2011 May;32(3):342-52
pubmed: 21146635
JAMA Intern Med. 2021 Feb 1;181(2):212-219
pubmed: 33226419
Trials. 2018 Sep 29;19(1):528
pubmed: 30268150
AIDS Care. 2000 Jun;12(3):273-8
pubmed: 10928203
AMA J Ethics. 2020 May 1;22(5):E423-429
pubmed: 32449659
Ann Intern Med. 2018 Sep 4;169(5):273-281
pubmed: 30083748
Clin Transplant. 2019 May;33(5):e13530
pubmed: 30865323