Successful Nurse-Driven Implementation of Hepatitis C Virus (HCV) Ab+/NAT+ Donor Acceptance Guideline for Heart Transplant: Single-Center Experience

Background Due to donor organ shortage, the number of patients listed for transplant greatly exceeds the supply of available heart allografts Recent approval of direct-acting antiviral (DAA) agents for HCV provides an opportunity to expand the donor pool through the use of organs from HCV NAT+ donors and offering highly-effective anti-HCV therapy to organ recipients who develop HCV infection Methods A heart transplant nurse coordinator identified an opportunity to increase donor pool by utilizing HCV NAT + donors The nurse coordinator researched and reviewed other national heart transplant programs’ experiences to support the model of accepting HCV NAT+ donors A review of our local Organ Procurement Organization (OPO) identified that approximately 4 to 6 HCV NAT+ donors may be available locally for transplant annually, with additional donors potentially available through distant procurement The nurse coordinator advocated for a change by first identifying a physician mentor and champion Next, key players needed to successfully launch the proposal were recruited as the core team Results A multidisciplinary task force was formed and included members from Transplant Infectious Diseases, Hepatology, Pharmacy, Cardiology, Cardiac Surgery, Quality, OPO, Administration and Risk Management The task force members conceptualized and executed a guideline for the use of HCV NAT+ donors The guideline addressed patient education, informed consent, co-infection testing, discharge treatment plan, therapy algorithm based on viral genotype, concomitant medications, financial support and outcome monitoring Next, patient consent form and practice guideline were approved by the hospital Patient Safety Committee and the transplant team Finally, the HCV NAT+ Protocol was fully implemented, 11 months after the initial decision to modify donor acceptance criteria Conclusion A nurse coordinator directed initiative for a major practice change was successfully implemented by collaborative coordination with key stakeholders in the Heart Transplant Program Quality and process improvement is an excellent way for a nurse coordinator to positively impact their program and patients This report identifies the resources and key steps needed to successfully implement guidelines for HCV NAT+ donor organ use in a heart transplant program.