Since the 1950s, organ transplant has become increasingly common, with nearly half a million candidates in the United States receiving an organ transplant each year.
Deceased donors account for 382,000 of these transplants, while over 100,000 come from living donors. Although over 173,000 people are living successfully with organ transplants in America today, a waiting list of 110,292 persons continues to grow.
Yet the number of available organs may decline, as organ transplant surgeons become hesitant to use organs from donors deemed “high-risk,” which have traditionally comprised 10 percent of the organ donation pool.
In 2007, four patients in Chicago received organ transplants from a sole donor who was unaware of his HIV-positive status, as the donor likely died in the “window period” between becoming infected with HIV and testing positive for antibodies with the use of nucleic acid testing, which reduces the “window period” to nine days. This refers to the time frame between becoming infected with HIV and when antibodies are present in the bloodstream.
This was the first event of its kind to occur in nearly twenty years, leading one-third of over 400 transplant surgeons surveyed nation-wide to use fewer organs from donors deemed to be “high-risk,” which the Centers for Disease Control has defined as including “intravenous drug users, men who have sex with men and prostitutes.” Although all organs are screened for such infections as HIV and Hepatitis C prior to transplantation, such tests do not always detect them, as antibodies may not yet be present.
Dorry Segev, an associate professor of Surgery at Johns Hopkins School of Medicine, studied the aftermath of the 2007 incident. The study, published in Archives of Surgery, aims to determine the attitudes of transplant surgeons towards the use of high-risk organs before and after the incident.
Segev and colleagues found that the majority of surgeons surveyed in the study have now emphasized “defensive medicine” in their consultations with those seeking an organ. New consent forms and counseling sessions prior to surgery highlight the risk of contracting HIV and other related infections, particularly as even the most advanced screening tests cannot detect recent infections.
Nearly 17 percent of surgeons now implement the use of nucleic acid testing (NAT) of organs prior to transplantation, which is the standard for all high-risk donors at Hopkins, so that anti-viral therapy may be initiated in the rare event that infection occurs, although it has yet been implemented nation-wide.
Yet the recent hysteria may do more harm than good. Organ transplantations, and furthermore, any surgery, does pose risks such as pneumonia, blood clots, infection and rejection of an organ. Yet due to fears of litigation, health care providers often opt to have recipients wait for an alternative organ rather than accept one from a high-risk donor.
Segev and his colleagues believe that high-risk organs should still be used with appropriate safeguards, such as previously mentioned NAT and informing patients of the risk and possibility of infection, as even organs from high-risk donors rarely cause infection and even lead to greater survival in those receiving them.
