The rare transmission of HIV through transplanted organs to four Chicago-area patients made headlines in 2007. A new study says it also caused some U.S. transplant surgeons to limit their use of organs from high-risk donors such as gay men.
CHICAGO (AP) — The rare transmission of HIV through transplanted organs to four Chicago-area patients made headlines in 2007. A new study says it also caused some U.S. transplant surgeons to limit their use of organs from high-risk donors such as gay men. That’s an "exaggerated response" based more on fear of lawsuits than on science, said senior author Dr. Dorry Segev of Johns Hopkins University School of Medicine in Baltimore. "The risk of death while waiting for an organ transplant is far higher for many patients than is the risk associated with these organs," Segev said. The study, based on survey responses from 422 transplant surgeons, found that about a third made changes following the 2007 events. Of those, 42 percent decreased their use of high-risk donors, 34 percent raised their emphasis on informing patients of risks and 17 percent increased their use of a more precise test for HIV infection in organ donors. The findings, appearing in Monday’s Archives of Surgery, show that a rare event can have "a major impact on the way medicine is practiced and is a reminder of the litigious environment we’ve created in medicine," Segev said. Nearly 1 in 10 organ donors is "high risk" under a definition set by the U.S. Centers for Disease Control and Prevention. The category includes men who’ve had sex with men in the past five years, people who’ve injected illegal drugs in the past five years and people who’ve engaged in prostitution in the past five years. High-risk donors help meet the great need for organs. More than 72,000 Americans are active waiting list candidates for organs. In 2009, 14,600 people donated organs, and about 6,700 people died because they didn’t get an organ in time. In 2007, it had been two decades since a recipient had contracted HIV from a donated organ and it was a surprise when the four Chicago-area patients got hepatitis C, as well as HIV, after receiving organs from one deceased, high-risk donor. The transplants, done at three Chicago hospitals, resulted in at least one lawsuit. An unnamed "Jane Doe" claimed the hospital hadn’t told her the kidney she received came from a man who had sex with men. That lawsuit against University of Chicago Medical Center is pending. The other two hospitals were Chicago’s Rush University Medical Center and Northwestern Memorial Hospital. It’s illegal to transplant an organ from someone known to be infected with HIV. But transplants from high-risk donors are allowed — as long as the risk is outweighed by the benefits. In 2007, standard tests for HIV and hepatitis antibodies showed the donor didn’t have the diseases. The donor may have acquired the infections a few weeks before death, too soon for the tests to detect antibodies. A nucleic acid test could have detected HIV earlier, but wasn’t done in the Chicago case. That’s now changed. Gift of Hope Organ & Tissue Donor Network, the federally designated organ procurement agency for northern Illinois and northwest Indiana, now uses the more costly nucleic acid test for all high-risk donors before transplants. The agency also uses the test after transplants on all other donors. University of Chicago Medical Center doesn’t rule out high-risk donors because the demand for organs outstrips the supply, hospital spokesman John Easton said. High-risk donor organs are used on a case-by-case basis. Rush University Medical Center has decreased its use of high-risk donors and ensures all patients are informed of the potential donor’s risk factors when organs from a high-risk donor are offered. Northwestern Memorial Hospital in Chicago automatically rules out some but not all high-risk donors. "Each organ offered is considered on a case-by-case basis, taking into account the donor’s condition at death and medical history, as well as the recipient’s health," said Northwestern spokeswoman Megan McCann. The 2007 event led to the strengthening of national policies. As of Jan. 10 of this year, policies require organ procurement organizations to make reasonable attempts to get the medical and behavioral history of donors. Transplant centers must tell recipients if the organ they’re being offered is from a high-risk donor and explain the risks and benefits. Hospitals must promptly notify organ procurement organizations of suspected infection transmission from organ donations so they can find other recipients who also may be affected. The new policies more clearly define how donors are screened for HIV. But the policies don’t require nucleic acid testing. A recent consensus conference concluded the test should be considered for high-risk donors but too many false positives make it unworkable, for now, as a universal screen. Copyright 2011 The Associated Press.
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