This weeks CDC MMWR reports an unfortunate case where a patient with kidney failure who received a kidney transplant from a living donor also acquired HIV/AIDS. The case, the first of its kind since 1989, is remarkable not because we don’t know that organ transplantation come with risks but rather it highlights the inadequacies of our current screening methods and the importance of potential organ donors being counselled to not engage in risky behaviours.
Since this particular case involved a living donor, it is likely that the recipient was familiar with him – maybe a relative or friend. Can you imagine going from feeling eternally grateful to someone giving you life to finding out that same person also put your life at risk?
Since this particular case involves a living donor, the time frame for testing and counselling is much prolonged. Between the 10 weeks from the donor being screened and testing negative for transmittable infections including HIV and the date of actual organ procurement/transplantation, the donor had engaged in unprotected sex with a male partner. I’m sorry, it’s 2011 (well it was 2009 at that time), did the donor not get counselled about his sexual behaviours and other recreational activities?
One may ask, if it was known that the donor was homosexual, why was he allowed to donate organs in the first place. After all in Canada, sexually active men who have sex with men (MSM) are barred from donating organs and n the US, they continue to be banned from donating blood. The ensuing argument is that these restrictions are based on homophobia and not on medical science.
It is not my place to decide whether men who have sex with men should be banned from donating blood or organs altogether, but medical science does suggest increased acquisition of sexually transmitted illnesses via unprotected anal sex and I would think that if I had a patient who engaged in unprotected anal sex, man or woman, I would discourage the person from doing so in a specified time-frame leading up to when they donate organs, blood, or tissue.
There are discussions that are going to need to be had.
Back in 2007, we were shocked to hear of a donor who had died several days after a car accident transmitting HIV and Hepatitis C to four patients who received his organs. One later died, and another, a woman in her 30s sued stating that if she had known the donor was homosexual, she would not have accepted the kidney as she had been stable on dialysis…and had previously turned down a kidney from a “high risk” donor. Hmmmm!
As it turns out, not only did the donor in the New York case fail the recipient, the current screening process did as well. 10 weeks is a long time to go between ruling out infections and procuring an organ…in a high-risk donor especially. But even if the donor had been retested in the week before procurement, if the unsafe sexual act was also closer to that time, the likelihood is that the current tests – tests that look for the body’s reaction to infection (antibodies) would have missed diagnosis as well as it takes no sooner than about three weeks for the immune system to build these antibodies. That was probably the situation in the 2007 Chicago case as testing of the dead donor at the time of organ procurement yielded negative antibodies to both HIV and Hepatitis C.
The CDC now calls for nucleic acid testing which can detect HIV (the virus itself) within 8 to 10 days – better; but there is still that lag window period, it is a more expensive test, takes longer to result, and can yield false positive results.
Overall, a very unfortunate case.
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