Evidence map›Paper›PMID 35248038›Full record

ArticleBMC medical ethics2022

Consent to organ offers from public health service "Increased Risk" donors decreases time to transplant and waitlist mortality.

Yvonne M Kelly, Arya Zarinsefat, Mehdi Tavakol, Amy M Shui, Chiung-Yu Huang, John P Roberts

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC medical ethics, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
1.4field-weighted citation impact, top 20% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 7 citations in OpenAlex.

  1. Review
  2. Article
  3. Trends in candidate hepatitis C virus nucleic acid amplification test (NAT)+ listing and associated impacts on liver transplantation waitlist outcomes.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2025
    Article
  4. The Public Health Service "Increased Risk" 2020 Policy Change Has not Improved Organ Utilization in the United States: A Nationwide Cohort Study.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2024
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 1 institution in 1 country.

Yvonne M KellyDepartment of Surgery, University of California, 400 Parnassus Avenue, A730K, San Francisco, CA, 94117, USA.
Arya ZarinsefatDepartment of Surgery, University of California, 400 Parnassus Avenue, A730K, San Francisco, CA, 94117, USA.
Mehdi TavakolDepartment of Surgery, University of California, 400 Parnassus Avenue, A730K, San Francisco, CA, 94117, USA.
Amy M ShuiDepartment of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
Chiung-Yu HuangDepartment of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
John P RobertsDepartment of Surgery, University of California, 400 Parnassus Avenue, A730K, San Francisco, CA, 94117, USA. John.roberts@ucsf.edu.
University of California, San Francisco · US

Funding

Filling a Void of Research (FAVOR) Training for Transplant SurgeonsT32AI125222 · NIAID · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI PETER G STOCK, Minnie M Sarwal · 2016 to 2026
$3.4M
NIAID NIH HHS T32 AI125222
6 · The paper itself

Abstract

backgroundThe Public Health Service Increased Risk designation identified organ donors at increased risk of transmitting hepatitis B, hepatitis C, and human immunodeficiency virus. Despite clear data demonstrating a low absolute risk of disease transmission from these donors, patients are hesitant to consent to receiving organs from these donors. We hypothesize that patients who consent to receiving offers from these donors have decreased time to transplant and decreased waitlist mortality.

methodsWe performed a single-center retrospective review of all-comers waitlisted for liver transplant from 2013 to 2019. The three competing risk events (transplant, death, and removal from transplant list) were analyzed. 1603 patients were included, of which 1244 (77.6%) consented to offers from increased risk donors.

resultsCompared to those who did not consent, those who did had 2.3 times the rate of transplant (SHR 2.29, 95% CI 1.88-2.79, p < 0.0001), with a median time to transplant of 11 months versus 14 months (p < 0.0001), as well as a 44% decrease in the rate of death on the waitlist (SHR 0.56, 95% CI 0.42-0.74, p < 0.0001). All findings remained significant after controlling for the recipient age, race, gender, blood type, and MELD. Of those who did not consent, 63/359 (17.5%) received a transplant, all of which were from standard criteria donors, and of those who did consent, 615/1244 (49.4%) received a transplant, of which 183/615 (29.8%) were from increased risk donors.

conclusionsThe findings of decreased rates of transplantation and increased risk of death on the waiting list by patients who were unwilling to accept risks of viral transmission of 1/300-1/1000 in the worst case scenarios suggests that this consent process may be harmful especially when involving "trigger" words such as HIV. The rigor of the consent process for the use of these organs was recently changed but a broader discussion about informed consent in similar situations is important.

Indexed as

HIV InfectionsOrgan TransplantationTissue and Organ ProcurementHumansInformed ConsentTissue DonorsWaiting ListsCommunicationIncreased riskInformed consentOrgan donationRisk perception

Identifiers

PMID35248038
PMCPMC8898499
OpenAlexW4221020047

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.