The combination of broad screening initiatives and development of effective antiviral therapies have led to a revolution in the treatment of hepatitis C virus and has reduced the proportion of patients with the virus who develop a need for liver transplantation in favor of other etiologies, such as alcohol-related liver disease and non-alcoholic steatohepatitis. However, the opioid epidemic and rise in injection drug use in the United States has simultaneously led to otherwise healthy hepatitis C viremic patients dying of overdoses. The sum total of all of these factors has large implications for the transplant community and those patients on the wait list for multiple different organs: lower numbers of people on transplant wait list have active HCV, while HCV is becoming more common in potential liver, kidney and thoracic organ donors. We will review the history of solid organ transplant from donors with hepatitis C as well as to describe the current understanding of the potential use of these grafts in light of the shifting demographics on the waiting list and potential donor population.
