Acute infection (= HEV-RNA detectable, not IgG-positivity)

At recruitment (only if donor reports, no test required):

ACCEPTABLE if free of symptoms

At CT (only if donor reports, no test required)

DEFER for 4 months.

• If entirely free of symptoms, re-evaluation is possible after 2 months
• If lasting hepatitis-like symptoms like fatigue, elevated liver enzymes, chronic HEV infection should be excluded (defined as persisting viremia >3 months)

At WU/PE (if test required by local regulations, or if medically appropriate, e g recent travel history)

DEFER for 4 months.

• If entirely free of symptoms, re-evaluation is possible after 2 months. Consult with TC.
• If lasting hepatitis-like symptoms like fatigue, elevated liver enzymes, chronic HEV infection should be excluded (defined as persisting viremia >3 months)

At collection day / in the product (if test required by local regulations, or if medically appropriate, e g recent travel history; results will typically be available only after donation)

Transplant centres must be aware that asymptomatic infection can occur after clearance if donor resides in or visits an endemic area, similar to WNV.

• INFORM transplant centre immediately
• Do not discard the product, but leave the decision to transfuse to the transplant centre
  As transplant centres might not be familiar with HEV, communicate that it might be acceptable to use the product after risk/benefit assessment, especially if the recipient has already been exposed to HEV.  

Chronic infection

DEFER donor until documented healing.

Background:

Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis world-wide. Over the last 10 years, human hepatitis E cases have been increasingly reported in Europe where genotype 3 (HEV-3) is common. The main reservoir of HEV in Europe are pigs and wild boar. The majority of the infections are asymptomatic or mild. In acute cases the disease is a self-limiting hepatitis affecting mostly male adults above 60 years of age; on rare occasions the infection can result in a severe, fulminant hepatitis with acute liver failure. [1]Only 5-20% of infected individuals develop symptoms of a hepatitis. Most people with acute infection recover completely within one to five weeks

In several countries, all blood products must be tested for HEV-RNA.

[1] https://www.ecdc.europa.eu/en/hepatitis-e/facts