An 8-Day Treatment for HCV-Positive Donor Organs: What a Toronto Study Means for OPCs

If you've worked as a coordinator for any length of time, you've had this moment. The labs come back, the donor is HCV NAT-positive, and you know some of the calls you're about to make will get harder.

That's changed a lot in the last several years. HCV-positive donor organs now go to HCV-negative recipients, because the antiviral drugs work so well. But the usual plan still means 8 to 12 weeks of medication after transplant, and that brings its own problems.

A new study out of Toronto looked at a much shorter course. Here's what it found, what it didn't prove, and why it matters for those of us on the donor side.

What the study looked at

Researchers at University Health Network's Toronto General Hospital published the study in The Lancet Gastroenterology & Hepatology on September 29, 2026. UHN announced it on October 16.

They looked back at HCV-negative adults who got a kidney, lung, heart, pancreas, or kidney-pancreas transplant from an HCV NAT-positive donor between February 2019 and December 2024. That came to 116 transplants from 72 donors:

  • 56 kidney
  • 34 lung
  • 16 heart
  • 6 kidney-pancreas
  • 4 pancreas

Every recipient got the Toronto HCV Protocol. That's three pills by mouth: glecaprevir, pibrentasvir, and ezetimibe. The first dose is given 6 to 12 hours before transplant, followed by seven more days after surgery. Eight days total.

What they found

  • All 116 recipients met the study's main goal. 114 had no detectable HCV RNA at 12 weeks. The other 2 died before 12 weeks, and neither had detectable virus at their last test.
  • UHN reports that no recipient developed chronic hepatitis C, needed more antiviral treatment, or had HCV-related problems.
  • For kidney, lung, and heart, the researchers matched recipients with similar patients who got organs from HCV-negative donors. Two-year survival was not statistically different for any of the three. Graft function at one year was similar too. (There weren't enough pancreas and kidney-pancreas cases to match, and none of those 10 recipients died.)
  • UHN's announcement puts two-year overall survival at 87.1%.
  • The paper reported no treatment-related deaths and no one stopping the drugs early. One kidney recipient had a serious liver enzyme rise that might have been from the treatment.

Why the shorter course matters

UHN points out that the longer standard course can mean waiting on insurance approval and getting the drugs filled after discharge. Those delays can push treatment back, and UHN says some patients have had serious problems because of it. Starting a short course before surgery, while the patient is still in the hospital, gets around much of that.

What it didn't prove

I want to be careful here, because this is the part that gets lost when research hits social media.

  • It was a retrospective study at one center. It looked back at records. It was not a randomized trial.
  • It did not compare 8 days head to head with the 8-to-12-week course.
  • The patients were treated at one experienced center with its own protocol. Results elsewhere may differ.
  • It does not change U.S. treatment recommendations or OPTN policy. Each transplant program decides how it handles HCV-positive organs.

What this means for coordinators

Here's how I'd think about it at work.

Donor suitability. An HCV NAT-positive result is not the end of the conversation for non-liver organs. Studies like this one add to the case that these organs can be used well in the right recipients.

Infectious disease screening. Know the difference between an antibody-positive, NAT-negative donor and a NAT-positive (viremic) donor. This study was about NAT-positive donors. Get the results documented clearly and shared quickly, because the transplant center's choice depends on them.

Allocation. Centers decide whether to accept HCV-positive offers and which recipients have agreed to them. If shorter, simpler treatment makes those organs easier to use, some programs may become more open to them over time. That's a maybe, not a promise.

Communicating with transplant centers. Timing matters. This protocol starts before surgery, so the receiving team needs the HCV results early enough to plan. Clear, fast updates on NAT results and timing help them get ready.

For the CPTC exam, this fits under donor testing and suitability. You won't be asked about one Toronto study, but you should be comfortable with what HCV antibody and NAT results mean and how they affect organ offers.

The bottom line

This study doesn't change the rules. It does show one center getting strong results with eight days of treatment instead of eight weeks or more. Every time the field finds a safe way to use more of the organs we already recover, someone waiting gets a better chance.

If you're new to the coordinator role and want a structured way to learn donor testing, suitability, and the rest of the job, the OPC Starter Pack ($200) is built to take a new coordinator toward CPTC-ready.

This article is for education only. It does not replace your OPO's training, your hospital's policies, or guidance from your medical director or transplant center. CPTCexam.com is independent and is not affiliated with, endorsed by, or sponsored by the American Board for Transplant Certification (ABTC). CPTC® is a registered mark of ABTC.

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