Cynthia Hobson-Albright had come to accept her three-day-a-week trips to a kidney dialysis center as a way of life. For six years, she spent several hours hooked to a machine that removed excess fluids and toxins from her body.
She didn’t complain—she even met her future husband, also on dialysis, at the center. Still, the treatment wore on her. So she put her name on the kidney transplant list in 2015. Three years later, one became available.
“[The doctor] said, ‘When can you be here?’” Hobson-Albright recalls. “I said, ‘Johnny-on-the-spot.’”
The 64-year-old had shortened her wait for the organ by agreeing to accept an atypical kidney—one infected with Hepatitis C.
“That’s how it started, and I [have] been fine ever since,” Hobson-Albright says.
She was part of a roughly 50-person observational study from the University of Tennessee Health Science Center and the James D. Eason Transplant Institute at Methodist University Hospital.
Doctors determined that kidneys infected with Hepatitis C are now acceptable to transplant into all eligible recipients.
“If we can use all of these kidneys, we can increase the donor pool,” says Dr. Miklos Molnar, one of the study’s authors and a transplant physician at Methodist University Hospital.
He says that up to 1,000 Hep C-positive kidneys are discarded every year. They were previously determined suitable only for patients already infected with the virus that can cause liver damage. But advances in anti-viral medication mean doctors can now cure the virus after the implant.
“These kidneys are otherwise excellent kidneys,” says Molnar, also an associate professor at UTHSC.
Some patients, he says, stay on the kidney transplant for up to eight years. The wait can be deadly; about five percent of patients die every year while waiting.
Dr. Christine Durand, an associate professor of medicine at Johns Hopkins, says that one residual effect of the opioid epidemic has been a surfeit of donor kidneys infected with Hep C, a virus most commonly spread by sharing needles, according to the Centers for Disease Control and Prevention.

“Sadly, the people who are dying from an opioid overdose are very young, under age 25,” Durand says. “These are ideal donors in other ways. They don’t have diabetes. They don’t have hypertension, they don’t have cardiovascular disease.”
Durand wasn’t involved in the UTHSC study but has conducted a similar clinical trial. She says there has been debate in the medical community over whether Hep C-infected kidney transplants should only be allowed in controlled clinical settings where more experimental therapies are offered.
Molnar’s study is the first he is aware of that documents this approach as standard care, meaning all eligible recipients at the Methodist University Hospital’s Transplant Institute are offered a Hep C-positive kidney when one becomes available.
Durand would like to see the practice become common across the country but says patient education and an extensive consent process is essential to maintaining public trust, given a stigma often associated with organs that come from donors who were drug users.
“Many of our patients will turn down organs from people with increased risk behaviors like injection drug use,” she says. “[But] we know these are very high quality organs. We have very sensitive testing methods to ensure that there’s not going to be HIV or Hepatitis or Hepatitis B transmission, but despite all that medical knowledge, there’s still a pretty high sense of stigma."
Molnar does not have statistics on how many patients have turned down an offer for a Hep C-positive kidney at the institute. But he says the hospital’s three-step consent process includes pre-surgery letters to patients informing them about the procedure, encouraging them to ask questions and having conversations with patients’ primary doctors and nurses.
He says that additional research is needed to understand the long-term effects of transplanting these types of kidneys.
Transplant patients are at high risk of BK virus, which is a treatable infection but can cause problems with people’s new kidneys. An “unexpected” number of patients in Molnar’s study had the virus post surgery, which he says requires further research to determine if the Hepatitis infected organs account for these elevated levels.
Still, both Molnar and Durand say that if on dialysis, they would accept an infected kidney.
“A patient’s quality of life is very bad on dialysis, so most of the patients—even with getting an infected kidney—they took the opportunity because everything is better than being on dialysis,” Molnar says.
Hobson-Albright agrees. She offers this advice to others considering a transplant: “Put your name on the list as early as you can.”