Evolving clinical realities and advances in transplant medicine are prompting a reconsideration of guidelines governing eligible organs and recipients—removing restrictions on organs from individuals with conditions such as hepatitis C (HCV), while allowing patients with conditions such as obesity and addiction to receive new organs. Such changes offer hope to the 110,000 people currently waiting for hearts, lungs, kidneys, and livers, and the providers working around the clock to find them suitable matches.

“There has been a sea change in how we think about allocating organs today,” says Joren Madsen, MD, DPhil, a cardiac surgeon who directs the transplant center at Massachusetts General Hospital (MGH). “By broadening the criteria for what constitutes an acceptable organ, patients who need organs the most will now have a greater chance of getting them.”

At MGH, a 74-year-old patient recently received a HCV-infected heart after three years on the waiting list. Once off-limits, organs from HCV-infected patients can now be transplanted into any willing recipient with the recent availability of an effective cure through antivirals. The MGH patient received treatment with his transplant and appears disease-free—along with all 30 recipients in pilot trials conducted at Johns Hopkins and the University of Pennsylvania.

Other organs could be newly available from at-risk individuals such as drug users or those recently incarcerated, making use of the thousands of organs previously discarded from such donors. Concurrently, rules such as a six-month sobriety requirement for patients with alcohol-associated liver disease are being reconsidered, and patients with obesity, which can lead to a buildup of fat in the liver, are now offered a combination bariatric surgery and liver transplant to enhance outcomes.

The hope is that someday, transplants could be available to everyone who needs one. “There are some amazing new technologies coming that have the potential to dramatically change how we do transplantation, such as reducing the need for immunosuppression, genetic editing to make animal organs suitable for use in humans, and stem cell technologies that will eliminate the need for some transplants,” says James Markmann, MD, PhD, Chief of the Division of Transplantation at MGH. “I can see a time when there will be no shortage of organs for transplantation.”

Read more in Proto.