Imagine this: You’re treating a patient with end-stage renal disease (ESRD) who has been on the kidney transplant list for almost a year. That’s not a surprising delay; more than 100,000 people are on the waiting list nationwide, and the median wait time is now over 3.5 years. So your patient probably has at least two more years to wait—years of dialysis in which he might become too sick to receive that transplant or die before it becomes available. (More than 4,700 people die awaiting a kidney transplant each year.)
Now consider that a kidney has suddenly become available. There’s just one catch: The donor, although otherwise healthy, had hepatitis C virus (HCV). You tell the patient that he will almost certainly develop acute HCV after the transplant, but that a regimen of new direct-acting antiviral drugs has a 98% chance of a cure. Should you advise the patient to take the guaranteed kidney now, knowing that it comes with a chronic disease but one that can be cured? Or should he stay with the uncertain wait time for a HCV-free kidney?
That’s a question that a group of patients and their caregivers at the University of Pennsylvania, in Philadelphia, will soon have to answer—and a question that may ultimately be put to many other people on the waiting list for kidneys and other organs.Share