For people waiting for an organ transplant, time can be the biggest obstacle. Every year, viable organs go unused because donors test positive for hepatitis C virus (HCV), raising concerns about transmitting the infection to recipients. A new UHN-led study suggests that a simple, eight-day treatment approach can safely overcome this barrier, potentially increasing the number of organs available for transplantation.

In a study published in The Lancet Gastroenterology & Hepatology, researchers reported outcomes from 116 kidney, lung, heart, pancreas, and kidney-pancreas transplantation procedures performed using organs from donors with active HCV infection. All recipients were treated using the Toronto HCV Protocol, a short course of antiviral medication beginning before transplant surgery and continuing for seven days afterward.

Notably, the results showed that all 116 recipients had no detectable HCV infection 12 weeks after transplantation or at their last follow-up assessment. No recipient developed chronic hepatitis C, required additional antiviral treatment, or experienced HCV-related complications.

"Our original study showed that this approach could work in 30 patients," says Dr. Jordan Feld, Senior Scientist at UHN’s Organ Systems & Integrated Health Sciences Research Institute and senior author of the study. "Now we have shown it can be implemented in routine clinical practice across multiple organ types with excellent long-term outcomes."

Historically, organs from donors with hepatitis C were rarely used in recipients who did not already have the virus. The development of highly effective antiviral medications changed that equation, but standard treatment approaches typically require eight to 12 weeks of therapy after transplant. This longer course can create logistical challenges and treatment delays while patients await insurance approvals and outpatient drug access. This has led to serious complications from delays in treating the hepatitis C.

The Toronto protocol takes a different approach: patients receive one dose of antiviral medication before surgery, followed by seven days of treatment after transplant. Most recipients completed the entire course before leaving the hospital.

Researchers also compared outcomes with matched transplant recipients who received organs from donors without hepatitis C. Across kidney, lung, and heart transplantation, survival and graft function were similar between the groups. Two-year overall survival among recipients treated with the Toronto protocol was 87.1 percent.

The findings build on years of work by UHN researchers to safely expand the donor pool. In North America, the devastating opioid overdose crisis has increased the number of otherwise healthy donor organs that test positive for hepatitis C. Making safe use of those organs can help more patients receive transplants sooner and bring a small positive out of these tragic deaths.

The researchers say the approach offers both clinical and practical advantages. By completing treatment during the initial hospital stay, the protocol reduces costs, minimizes drug-related complications and avoids potentially harmful delays that can occur with longer treatment courses.

For patients facing lengthy waits for a life-saving transplant, that could make a meaningful difference.

Dr. Wesam Aleyadeh is a transplant hepatology fellow and researcher affiliated with University Health Network. He is the first author of the study.

Dr. Marcelo Cypel, Senior Scientist at UHN’s Ajmera Transplant Centre and Professor in the Department of Surgery at the University of Toronto, and Dr. Atul Humar, Senior Scientist at UHN’s Ajmera Transplant Centre and Professor in the Department of Medicine at the University of Toronto, are co-authors of the study.

Dr. Jordan Feld, Senior Scientist at the University Health Network, Director of the Toronto Centre for Liver Disease, and Professor of Medicine at the University of Toronto, is the senior author of the study.

This research was supported by the Canadian Institutes of Health Research and UHN Foundation.

Aleyadeh W, Cypel M, Kim SJ, McDonald MA, Schiff J, Alba AC, Keshavjee S, Yacht K, Munyal D, Allan R, Wang J, Kumar D, Humar A, Feld JJ. Short-course prophylaxis with the Toronto HCV protocol for recipients of non-liver solid organ transplants from donors with hepatitis C viraemia: a retrospective, matched cohort study. Lancet Gastroenterol Hepatol. 2026 Sep 29:S2468-1253(26)00237-2. doi: 10.1016/S2468-1253(26)00237-2. Epub ahead of print.