Thread: 4 Transplant Recipients get HIV from Donor

4 transplant recipients get HIV from donor
Donor's infection is 1st such case in U.S. in 22 years
By Jeremy Manier | Tribune staff reporter
November 13, 2007
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Digg Del.icio.us Facebook Fark Google Newsvine Reddit Yahoo Print Single page view Reprints Reader feedback Text size: Four transplant recipients in Chicago contracted HIV from a high-risk organ donor whose infection went undetected in what hospital officials say is the first documented case of the virus being transmitted by organ donation in the U.S. in more than 20 years.

The transplants occurred in January at three Chicago hospitals, but the patients did not learn until the last two weeks that they were infected with HIV and the virus for hepatitis C. One doctor said the news was "devastating" to the patients.

Hospital and organ donation officials said the infections arose because of a rarely encountered flaw in the test used to detect those diseases -- a flaw that more sensitive tests could help fix, some experts believe. Officials said there is no significant threat to other organ recipients, and no other patients received the infected donor's organs or tissue.



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A screening questionnaire determined that the organ donor had engaged in high-risk behavior, said officials at Gift of Hope Organ & Tissue Donation, the Elmhurst-based organ procurement agency that tested and approved the organs for donation.

But tests for HIV, hepatitis and other conditions came back negative, most likely because the donor had acquired the infections in the last three weeks before death.

Officials would not release any personal details about the donor or recipients, citing medical privacy laws. It is unknown how the donor died.

Based on the negative test results, doctors at Northwestern Memorial Hospital, Rush University Medical Center and the University of Chicago Medical Center went ahead with the transplants, said officials at those centers.

"It's a risk-versus-benefit calculation," said Alison Smith, vice president for operations at Gift of Hope. "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."

Smith said her agency "followed the right procedures" in testing the donor. She attributed the failure to an inherent limitation of the standard ELISA test that facilities use to detect HIV and hepatitis C.

Patients who contract HIV up to 22 days before being tested turn up negative because their immune systems have not yet made the antibodies that the test is designed to detect. The latent window can be even longer for hepatitis.

A newer test called NAAT appears to reduce the window of time in which infected patients may go undetected, said Dr. Michael Millis, chief of the transplantation program at the U. of C. He said the HIV infections 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 percent safe and it is never going to be 100 percent safe, at least with technology we have today," Millis said.

"The process needs to be done as well as it can be, and I think we can improve it," Millis said.

U. of C. officials disclosed the problem to the Tribune on Monday, saying they wanted to explain how the infections happened and assure potential organ recipients that the system remains safe.

Experts said patients with concerns should contact their doctors or transplant centers with questions.

The crisis has spurred regular conference calls among doctors at the hospitals and officials with the United Network for Organ Sharing (UNOS) and the federal Centers for Disease Control and Prevention. The hospitals said they are cooperating with an epidemiological investigation that the CDC is conducting concerning the cases.

A UNOS spokesman said this is the first known example in the U.S. of HIV transmission from an organ donor since a case in 1985, when the AIDS virus was still relatively new and few safeguards were in place to prevent transmission.

Since then, there have been more than 400,000 organ transplants in the U.S. without a reported case of transmission through organs.

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

Federal guidelines specify which potential donors are considered at high risk for HIV and how hospitals should handle that information.



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I would be checking who and how they are sterilizing surgical equipment ....yikes