For the first time in more than 20 years in the U.S., there are documented cases that the HIV virus has been transmitted from a high-risk organ donor to transplant recipients.
The transplants occurred in January at three Chicago hospitals, but the four patients who were infected with HIV and the virus for hepatitis C did not learn of their status until the last two weeks, according to medical officials.
A screening questionnaire determined the organ donor had engaged in high-risk behavior, according to officials at Gift of Hope Organ & Tissue Donation, the Elmhurst, Ill. 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. Personal details about the donor were not released by medical official officials, who cited privacy laws.
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, based on the negative test results.
"It's a risk-versus-benefit calculation,'' Alison Smith, vice president for operations at Gift of Hope, told the Chicago Tribune. ``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.''
The right procedures were followed in testing the donor, according to Smith, who attributed the failure of the standard ELISA test to detect HIV and hepatitis C to the inability of the test facilities use to detect the virus in newly infected people.
A newer test called NAAT appears to reduce the window of time in which infected patients may go undetected, and Illinois should consider using it, said Dr. Michael Millis, chief of the transplantation program at the University of Chicago Hospitals.
"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 his staff was told of the problem on Nov. 1, and brought in the two patients who had transplants there for testing the next morning.
"It was very surprising and devastating for them, I'll be honest, just as it would be for any of us,'' Millis said.
A spokesman for the United Network for Organ Sharing said the last known example of HIV being transmitted from a donor to a recipient was 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.
The Centers for Disease Control and Prevention guidelines advise excluding high-risk patients 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.''