Rare HIV Transmission Changed Transplant Practice

On Nov. 13, 2007, the media widely published the news that several HIV transmissions had resulted after donated organs were transplanted from a deceased high-risk donor. Though this was the first such transmission in 20 years, it prompted an "exaggerated" response by some US transplant surgeons, a new study suggests.

CDC-defined high-risk organ donors (HRDs) include those who, in the past five years, have engaged in specific risk behaviors: men having sex with men, drug injecting, and sex work.

Between January and April 2008, researchers surveyed 422 working US transplant surgeons about their attitudes and practices following the 2007 transmission event.

Among respondents, 31.6 percent said they had changed their practice, including 41.7 percent who had decreased use of HRDs and 34.5 percent who emphasized the risks during informed consent counseling. Just 16.7 percent increased their use of nucleic acid testing (NAT), and 6 percent adopted a formal policy. Fear of being sued or hospital pressure was associated with more than a two-fold higher odds of changing practice, with medical risks of HIV associated with an 8.29-fold odds of decreasing HRD use.

"The risk of death while waiting for an organ transplant is far higher for many patients than is the risk associated with these organs," said study leader Dr. Dorry Segev of the Johns Hopkins University School of Medicine.

In 2009, 14,600 people donated organs, and about 6,700 people died waiting for such a donation. More than 72,000 Americans are on a waiting list for organs.

The 2007 transmission case involved donated organs from a man who had sex with men. Standard antibody tests for hepatitis C and HIV came back negative, and his organs were transplanted into four recipients, who later turned up infected with both viruses. NAT, which can detect more recent HIV infections than antibody tests, is now used at the organ procurement center that distributed the organs in the 2007 case.

The study, "Provider Response to a Rare but Highly Publicized Transmission of HIV Through Solid Organ Transplantation," was published in the Archives of Surgery (2011;146(1):41-45).

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