Surgeons spooked by -- and overreacting to? -- 2007 HIV-positive organs incident

January 18, 2011

January 17, 2011|By Eryn Brown, Los Angeles Times

In November 2007, four organ transplant recipients in Chicago contracted HIV and

hepatitis C from a deceased " high risk " organ donor.

It was a nightmare scenario, to be sure, but it was also an extreme rarity: the

first documented case of HIV transmission through an organ transplant in more

than 20 years.

Still, the ripple effect for surgeons who perform organ transplants has been

significant, according to a study published Monday in the journal Archives of

Surgery . Nearly a third of 422 practicing transplant surgeons surveyed by a

s Hopkins research team in early 2008 changed the way they evaluate organs

from " high risk " donors as a result of the 2007 incident, they reported.

While it's great that surgeons are aware of risks and take appropriate

precautions, the researchers suggest, they might not be making changes to policy

that help patients most. Rather, most of the adjustments made could have been

considered " defensive medicine " -- moves designed to protect the surgeon, who

might fear getting sued, rather than transplant patients, who desperately need

donor organs.

For example, 41.7% of the surgeons who said they changed their practices

reported decreased use of high-risk donors. An additional 31.6% said that they

ramped up their emphasis on informed consent -- getting patients to assume

responsibility for unlikely complications.

But different types of changes might have better served patients. In the 2007

case, the donor's antibodies tested negative for HIV and hepatitis C, but later

nucleic acid testing was positive, which means that the donor may have died

during what is called the " window period " between infection and detectability.

Increased use of nucleic testing could have flagged the organs in time, making

it unnecessary to turn away all organs from high-risk donors at a time when

organs are in such short supply.

The Hopkins team wrote that the chance of getting HIV or hepatitis C from a

high-risk organ is not much higher than the risk of acquiring either disease

while awaiting transplant. More than 8% of organ donors are high-risk.

" Given the severity of the organ shortage and high incidence of waiting-list

mortality, centers should strive for appropriate rather than decreased use of

high risk donors, " the team wrote.

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