Organ Transplant Safety

Four patients in Chicago who received organ transplants from the same donor were found positive for HIV. According to the US Centers for Disease Control and Prevention, the last time HIV was reportedly transmitted through infected organs was in 1986.

Two viruses were actually transmitted: HIV and hepatitis C. This was the first instance where two different viruses were reported to have been simultaneously transmitted by an organ transplant. The transplants took place in January but the infections were discovered by chance in November, 10 months later.

There was no official information on the organs involved in the transplants, but an independent expert on transplants said these probably were the kidneys, liver, heart or lungs. No other organs or tissues were removed from the donor.

The CDC said this incident could have serious policy implications on the screening system for infections in organ donors. The weak link in the system is well known: the common tests employed do not always detect viruses if the tests are conducted in the early stages of the viral infection.

* The donor initially tested negative for the two viruses. The tests do not detect the virus but the antibodies produced in reaction to the viral infection. However, it takes time for the body to react to the infection. Usually, antibodies cannot be detected until after 22 days for HIV and 82 days for hepatitis C infections. If the test is done too soon, results will be negative.

* A more sensitive test, the nucleic acid amplification test (NAAT), can detect the genetic material of the virus itself. The detectable period is reduced to 12 days for HIV and 25 days for hepatitis C. But the test is not widely available and is acknowledged to be more difficult and time-consuming. The time element is important in organ transplants because organs deteriorate rapidly after the donor’s death. An equally important concern is that NAAT has greater likelihood of yielding false-positive results — and could cause unnecessary wastage of healthy organs.

* From the start, the organ donor was determined “high risk.” Federal guidelines do not recommend using organs from high-risk people for transplants unless there is immediate threat to life of the recipient without a transplant.

* The high-risk classification also required, under CDC guidelines, that transplant recipients must be tested for HIV 3 months after the transplant, despite a negative finding in the initial HIV test. The failure to follow CDC’s recommendation indicates that few hospitals did not take the risk of transmission seriously enough, although experts acknowledge the risk of transmission is rare.

Safety Tip:

* If you’re scheduled for a transplant, ask your doctor to inform you of the donor’s status. Some hospitals inform the patient or family members if a donor is classified a high risk, and require them to acknowledge having received the information in a special consent form.

* Remind your doctor to test you again after 3 months, even if the organ donor initially tested negative for HIV.