Four Transplant Recipients Contract HIV, Hepatitis C From High-Risk Organ Donor

Main Category: Transplants / Organ Donations
Also Included In: HIV / AIDS;  Liver Disease / Hepatitis
Article Date: 15 Nov 2007 - 10:00 PDT

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Four transplant recipients in Chicago in January contracted HIV and hepatitis C from a high-risk organ donor due to a "rarely encountered flaw" in the test used to detect those diseases, the Chicago Tribune reports. A United Network for Organ Sharing spokesperson said this is the first known example in the U.S. of HIV transmission from an organ donor since a case in 1985.

According to officials at Gift of Hope Organ & Tissue Donor Network -- the organ procurement agency that tested and approved the organs for donation -- a screening questionnaire determined that the organ donor had engaged in high-risk behavior. However, tests for HIV, hepatitis and other conditions came back negative, indicating the donor most likely contracted the diseases in the last three weeks of his or her life, according to the Tribune. HIV-positive people could test HIV-negative for up to 22 days after contracting the virus because antibodies detected by the test are not yet present, and the latent period can be longer for hepatitis C, the Tribune reports.

Based on the test results, physicians at Northwestern Memorial Hospital, Rush University Medical Center and the University of Chicago Medical Center went ahead with the transplants, according to officials from the centers. Alison Smith, vice president for operations at Gift of Hope, said the agency "followed the right procedures" in testing the donor. Smith attributed the failure to a limitation of the standard ELISA test that facilities use to detect the diseases. A newer test, called NAAT, appears to reduce the time in which HIV and hepatitis C are undetectable, Michael Millis, chief of the transplantation program at the UC Medical Center, said.

Officials would not disclose personal details about the donor or the organ recipients, or the donor's cause of death because of medical privacy laws. There were more than 400,000 organ transplants in the U.S. without a reported case of transmission since the 1985 case, the Tribune reports (Manier, Chicago Tribune, 11/13).

Officials from CDC and the Chicago Department of Public Health are investigating whether the four organ recipients could have transmitted HIV to others because they were unaware of their infections, the Chicago Tribune reports (Manier, Chicago Tribune, 11/14).

Reaction
According to CDC guidelines, high-risk patients should be excluded from organ and tissue donation "unless the risk to the recipient of not performing the transplant is deemed greater than the risk of HIV transmission and disease." Smith said, "It's a risk-versus-benefits calculation," adding, "Every patient in need of an organ has a significant medical condition that in most circumstances limits life expectancy. The question becomes what degree of risk is appropriate in that situation."

Joel Newman, a spokesperson for UNOS, said, "We believe there's already a very small risk of transmission through the safeguards we have in place."

Millis said that the four cases suggest that Illinois should consider instituting a new NAAT testing center. "The organ supply is extraordinarily safe, but this has demonstrated that it's not 100% safe and it is never going to be 100% safe, at least with the technology we have today," Millis said, adding, "The process needs to be done as well as it can be, and I think we can improve it" (Chicago Tribune, 11/13).

Additional Coverage
Several other newspapers also reported on the organ transplants. Headlines appear below.

• "'Grief, shock' for organ recipients with HIV" (Newbart, Chicago Sun-Times, 11/14).
  
  
• "Four Transplant Recipients Contract HIV " (Grady, New York Times, 11/14).
  
  
• "Chicago organ donor infects four with HIV" (Moore, Washington Times, 11/14).

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