Transplant Surgeons Changed Practice after HIV/HCV Transmission Case

Transplant Surgeons Changed Practice after HIV/HCV Transmission Case
By Peter Laird, MD

In 2007, the news that four patients received HIV/HCV contaminated tissues from a high risk organ donor rocked the transplant medical community which still affects decisions on donors today. One of the patients who received a kidney transplant sued because she was not informed that the donor was a high risk patient. Unfortunately, even though the donors tests were negative for HIV/HCV at the time of donation, his high risk behaviour as a 38 year old gay man led to an undetected infection which he passed on to the recipients of his organs. The publicity surrounding this case still governs transplant practices among many of the nations transplant surgeons.

Transplant Docs Change Practice After HIV/HCV Case

In 2007, transplants from a single high-risk donor transmitted both HIV and hepatitis C to four organ recipients, despite negative antibody tests before the procedures. The case made national headlines, Segev and colleagues noted, and sparked a debate about informed consent and testing for HIV. . .

To see what effect the case had, Segev and colleagues surveyed transplant surgeons across the U.S. between Jan. 17, 2008, and April 15, 2008, getting responses from 422 surgeons in current practice.

Of those, they found, 297 reported using high-risk donors, but 31.6% changed practice after the 2007 event. Specifically:

41.7% of those who changed decreased use of high-risk donors.
34.5% increased the emphasis on informed consent.
16.7% increased use of nucleic acid testing.
6% implemented a formal policy.
In this specific case, CDC guidelines on high risk donors were over looked when the patients were not informed of the donors high risk status. The patient that sued after her renal transplant had previously turned down an earlier transplant because the donor was likewise high risk. In this case, the transplant surgeons were all aware of the donor’s status but did not pass that information on to the patients. All four recipients later turned positive for both Hep C and HIV, the first such documented transmission in 20 years.

Transplant Patient a 'Mess" after HIV Diagnosis

CHICAGO — A woman in her 30s who is one of the four organ transplant patients infected with HIV and hepatitis was not told that the infected donor was high risk, and had previously rejected another donor “because of his lifestyle,” her attorney said.

Attorney Thomas Demetrio filed a petition Thursday in Cook County Circuit Court on behalf of the woman, asking officials to keep a hospital and an organ procurement center from destroying or altering any records involving the donation.

“She’s really a mess right now,” Demetrio said of the Chicago-area woman. “She’s still in shock.”

In the rush to increase organ donations, taking shortcuts on any aspect of this care is paid in the end analysis by the unfortunate patients who learned that their life saving transplant gave them two deadly viruses at the same time. The current caution on the part of transplant surgeons who have changed their practice standards because of this case is prudent and should be encouraged. Throwing caution to the wind is a losing strategy in any situation, this one turned out to be tragic.

How terrible.

Wendy, there was a lot of information in the medical literature at that time how to increase donation rates including using high risk donors. One of the ideas at that time was to have a one-time informed consent at the time of going onto the wait list and then no information about the donor at the time of donation including these high risk donors.

They proposed this since a great number of patients decline the high risk behavior donors and with good reason in my opinion. I haven’t heard anymore about that proposal since this terrible case. Hopefully, there will never be another. Taking short cuts just doesn’t work for anyone including the health care team that withheld information that they already knew just to go along with increasing the number of high risk donors utilized.

The bottom line is true informed consent must accompany all procedures at the time of the procedure. Unfortunately, this is a very sad way to remind all of the importance of doing just that.

I just started meeting with the Swedish Transplant team. In the first meeting last week they said for all high-risk donors, transplant recipients must be informed first and the recipient must give their specific consent to receive a kidney from that particular high risk donor. If the recipient declines because of the high risk status, he will not be ‘penalized’ for rejecting it. I was happy to hear that.