4 Organ Recipients Infected With HIV

[Nutmegger]

Source: CBS

CHICAGO (CBS) ― There are new questions about the safety -- and risks -- of organ donation. As CBS 2 Medical Editor Mary Ann Childers reports, this comes after four patients at three Chicago hospitals got HIV – which causes AIDS – after receiving infected donor organs.

This is the first known instance of HIV transmission from an infected donor in the U.S. in more than 20 years. It happened despite proper procedures for testing donors and organs that experts say were followed to the letter by the Elmhurst-based Gift of Hope Organ & Tissue Donor Network, which serves Illinois and northwest Indiana.

Gift of Hope says the organs tested negative for HIV and hepatitis C because it takes 22 days from the time a person is infected until their immune system forms antibodies blood tests can detect. The donor was tested to rule out the presence of any transmissible disease. Tests for HIV, hepatitis and other conditions came back negative, possibly because the donor had acquired the infections in the last three weeks before death, or because the tests might not have picked up the diseases.

"These tests are not infallible," said Alison Smith of Gift of Hope. "There's limitations on these tests."

Read more: http://cbs2chicago.com/local/hiv.organ.transplant.2.566288.html

[Ian David]

1. Want to bet those organs came from China? n/t

[seriousstan]

3. Yes i would. How about a donor star to the person of your choice?

[Ecumenist]

2. Oh my God... How horrible to think that these folks were getting transplants

in the hope for a new and healthier life and now, they face a death sentence. Treating HIV and the necessity of immunosuppressive therapy to maintain the transplanted organs will be no fun..

[pinto]

4. Sad. And the facts are correct. A recent infection may not show up on an antibody test -

it takes a while for the body to amount a sufficient antibody response to react on a test, and, in that time period, the viral load and infectivity are great. For HIV, ~ 3 weeks, at a minimum. Sadly, the slim risk remains.

The only better option would be a viral load test on transplant donors, that would show up earlier than an antibody test. In the case of a deceased donor, though, the viral load test would take longer than the organs remain viable for transplant, iirc. An antibody test can be done in twenty minutes.

Hopefully the recipients will have good access to care, should they need it, or when they need it. (Chicago has good resources for HIV care.)

[TZ]

7. Actually the really accurate antibody tests take 4-6 hrs actually

I'm a bit suspicious of the accuracy of the 20 minute tests. The error rates (false positive, false negative) are probably higher. Since organ donation has a definite time period limitation, the most accurate testing for HIV is often not available..As someone said, this is sadly one of the risks of transplantation, and all things considered its pretty amazing this doesn't happen more often.

[pinto]

10. No. The so-called 'rapid test' parallels accuracy for a serum ELISA.

The main glitch we saw (I do HIV testing) were false positives in the earliest test kits. They came up negative on follow-up testing.

Later test kits have been accurate across the board with other testing procedures.

As you know, epidemiologically, and clinically, a false positive is better than a false negative.

From the client's perspective it's a rough roller coaster, but we work to explain the possibilities to all.

[kestrel91316]

5. This is one of the INHERENT RISKS of transplantation.

Nobody can be blamed. It's no one's "fault". There is no one to sue.

You gotta take those organs when you can get them, and don't have the luxury of waiting weeks to repeat tests before transplanting.

We need better screening to ID persons infected with HIV and get them treated so they aren't spreading it willy-nilly to the unsuspecting.

[pinto]

8. It is also a risk/benefit decision on the part of recipients and medical staff.

Agree, there is no blame to be made, apparently. And it seems all protocols were followed, from the sketchy report. There remains a slim risk. I suspect all were told that, as in any surgical procedure.

I think it's worth noting that risk can not be reduced to zero in that venue, as the doctor quoted mentioned.

The current antibody screening is very accurate and quick - 20 minutes. Yet, it won't react to a recent infection.

(aside) The donor may not have known s/he had HIV, and may not have been spreading the virus 'willy-nilly', nor may have the recipients been unsuspecting, if given adequate risk counseling before the procedures.

[kestrel91316]

16. No medical procedure is zero risk (I know this is mind-boggling to many, lol).

NONE. Anyone who thinks their procedure is 100% fooproof is deluding themselves. I guarantee you the recipient signed half a dozen or more forms detailing the risk of HIV and umpteen other infectious diseases, probably including rabies.

[mike_c]

6. this is a legitimate risk IMO-- everyone seems to have done everything right....

And putting myself in the position of the organ recipients, I mean, you're on the recipient list because you're in mortal straits anyway, so no one in their right mind would use this sort of accident to justify not accepting a transplant just so they could die anyway.

[XemaSab]

14. Beats the shit out of rabies

Investigation of Rabies Infections in Organ Donor and Transplant Recipients --- Alabama, Arkansas, Oklahoma, and Texas, 2004

On June 30, 2004, CDC confirmed diagnoses of rabies in three recipients of transplanted organs and in their common donor, who was found subsequently to have serologic evidence of rabies infection. The transplant recipients had encephalitis of unknown etiology after transplantation and subsequently died. Specimens were sent to CDC for diagnostic evaluation. This report provides a brief summary of the ongoing investigation and information on exposure risks and postexposure measures.

Organ Donor

The organ donor was an Arkansas man who visited two hospitals in Texas with severe mental status changes and a low-grade fever. Neurologic imaging indicated findings consistent with a subarachnoid hemorrhage, which expanded rapidly in the 48 hours after admission, leading to cerebral herniation and death. Donor eligibility screening and testing did not reveal any contraindications to transplantation, and the patient's family agreed to organ donation. Lungs, kidneys, and liver were recovered. No other organs or tissues were recovered from the donor, and the donor did not receive any blood products before death. The liver and kidneys were transplanted into three recipients on May 4 at a transplant center in Texas. The lungs were transplanted in an Alabama hospital into a patient who died of intraoperative complications.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5326a6.htm
--------------------------------------
What Precautions or Contraindications Exist for Rabies Vaccination?

Immunosuppression
Immunosuppressive agents should not be administered during postexposure therapy unless essential for the treatment of other conditions. When postexposure prophylaxis is administered to an immunosuppressed person, it is especially important that a serum sample be tested for rabies antibody to ensure that an acceptable antibody response has developed.

Corticosteroids, other immunosuppressive agents, anti-malarials, and immunosuppressive illnesses can interfere with the development of active immunity after vaccination. For persons with immunosuppression, preexposure prophylaxis should be administered with the awareness that the immune response might be inadequate.

Patients who are immunosuppressed by disease or medications should postpone preexposure vaccinations and consider avoiding activities for which rabies preexposure prophylaxis is indicated. When this course is not possible, immunosuppressed persons who are at risk for rabies should be vaccinated by the IM route and their antibody titers checked. Failure to seroconvert after the third dose should be managed in consultation with their physician and appropriate public health officials.

[humbled_opinion]

9. More reasons to find a cure... HIV has many impacts on many people...n/t

[Jersey Ginny]

11. Tragic, but some perspective needed

Anyone getting an organ transplant is facing imminent death. It is amazing that medical science can now preserve our lives through miraculous transplants. I don't know for sure, but if HIV acts on them like others, they are facing a long term chronic condition that may never be as life threatening to them as was their failed organs. Given the choice of no organ transplant because of the remote chance I will get HIV or death, I'll take those odds and if I got HIV, I'd be unlucky, but alive at least.

[Orangepeel]

12. true. The story says it is a risk of organ donation, but it is a risk of organ transplation

a remote chance, fortunately, that almost all transplant patients would be willing to accept, just as they accept the risks of infection and rejection in order to have a chance at life.

[pinto]

13. Good points, both.

:thumbsup:

[w8liftinglady]

15. true.and having worked with tons of transplant patients,I can tell you

that the anti-rejection drugs-especially for lung transplants,far exceed HIV in "Risk".All transplant patients know that rejection is the risk they take when getting an organ.It can be a much uglier death than HIV or hepatitis.

[JeanGrey]

17. I am a transplant patient myself. I was near death when I received

it three years ago. This year I am battling cancer in both lungs caused by immo-suppressive drugs. Would I do it over? You bet. I now have a tremendous amount of health problems but my quality of life is still ok at times. It sure beats death.