Organ Transplantation From Nonstandard Risk Donors: Midway Between Rigid and Flexible Rules

In order to bridge the gap between available organs and patients needing transplants, donor selection criteria for donors are increasingly being extended; the possibility of using organs from nonstandard risk donors has been introduced in many countries. This clearly poses considerable ethical issues that should be analyzed and taken into consideration by the competent bodies and institutions. In this article, we illustrate the Italian situation regarding the possibility of using organs from anti-hepatitis C virus (HCV) and HCV RNA-positive donors (anti-HCV+ve) in negative recipients (healthy subjects who have never come into contact with the hepatitis C virus) in light of the availability of new direct-acting antiviral drugs (DAAs) for hepatitis C treatment. We discuss the motivations behind the both favorable opinions of the Ethics Committee of the Italian National Institute of Health (Istituto Superiore di Sanità) and the Italian National Bioethics Committee (Comitato Nazionale per la Bioetica) discussing the main implications from an ethical point of view. •The ISS CNT proposed the use of anti-HCV+ and HCV-RNA+ donors for anti-HCV- patients.•The proposal is justified by the availability of new DAAs.•The Italian ISS EC and the Italian NBC expressed favorable opinions.•AIFA expressed the willingness to redefine the criteria for the reimbursement of DAAs.•The use of anti-HCV+ donors can expand the total donor pool of about 2%.