News & Politics - 4 patients get HIV from organ donor

migamoo · 11-13-2007, 08:48 PM

Quote:

4 patients get HIV from organ donor - Yahoo! News

CHICAGO - A troubling case in which a high-risk organ donor infected four patients with the AIDS virus and hepatitis has led medical ethicists to warn that patients need to know more about whose organs they're getting.

Public health officials said Tuesday the Chicago case is the first known instance of HIV transmission through organ transplants since 1986.

It's also the first ever known instance in which one organ donor has spread hepatitis C and HIV at the same time, said Dr. Matt Kuehnert of the federal Centers for Disease Control and Prevention.

The CDC and other public health officials are investigating the Chicago cases.

But they emphasized that the risk of getting any disease from transplanted organs is less than 0.01 percent. Noting that more than 400,000 transplants have occurred nationwide in the past two decades, they called the transplant system safe.

But it's not 100 percent safe: Standard testing failed to detect HIV in the Chicago case. People waiting for organs should be told as much pertinent information as possible about potential donors, said University of Pennsylvania medical ethicist Art Caplan.

Transplant surgeons generally decide what information is given to patients and their families. Sometimes it's not much because of the circumstances — patients are very sick, organs are scarce and usable for only a short time, Caplan said.

"You really have to put your faith in the transplant surgeon," agreed Ronald Taubman, who received a kidney-pancreas transplant six years ago.

The suburban Los Angeles man said he rejected one kidney because of concerns raised by his doctor, and was lucky that a better one became available.

But Caplan noted that not all patients have that choice.

"It's obviously very, very difficult because the availability of organs is such that if you pass, there's a possibility you won't get one," he said. Still, the Chicago case shows that to make an informed decision, patients "have a right to more information" than doctors often give, Caplan said.

Not every aspect of a potential donor's life is fair game, but patients have a right to know "if a donor dropped dead in a bathhouse with a needle in his arm," Caplan said.

It's not clear why the donor in the Chicago case was considered high-risk, or how much the four patients were told. But University of Minnesota ethicist Jeffrey Kahn said it underscores the importance of the consent process "and an individual's right to decide what's right for them."

Officials declined Tuesday to identify the Chicago patients, the donor or what organs were transplanted.

The four patients got their organs in January at Northwestern Memorial Hospital, Rush University Medical Center and the University of Chicago Medical Center. Two had their operation at the University of Chicago hospital.

That hospital issued a statement Tuesday saying the donor died after "traumatic injury" but wouldn't provide more detail.

The cases came to light within the past two weeks after one of the patients was evaluated for a possible "re-transplant" and had blood tests, the hospital said.

A screening questionnaire revealed that the donor had engaged in high-risk behaviors, said Alison Smith of Gift of Hope Organ & Tissue Donor Network, the Elmhurst, Ill., group that procured the organs. She declined to elaborate, citing privacy concerns.

High-risk behaviors include gay men having sex within the past five years, people having sex for money or drugs within the past five years, and intravenous use of recreational drugs within the past five years. The CDC says people in any of these categories should be excluded as organ donors unless the need outweighs the risks.

The Chicago hospitals were told that the donor was high-risk, but none would say what information was relayed to the patients or their families.

Initial tests on the donor for HIV, hepatitis and other conditions came back negative, most likely because the donor had acquired the infections in the last three weeks before death.

It takes 22 days from the time of exposure to HIV for antibodies to be picked up in the standard HIV test. During that time, a person can still be infectious.

Because of that lag, there's growing support for a newer costlier test that can detect the virus earlier but takes several hours longer to get results.

Not many centers use it, including the Gift of Hope. Because of the Chicago cases, momentum favoring it likely will grow, said Dr. Michael Millis, chief of transplantation at the University of Chicago Medical Center.

"We have to reassure the person that's coming in for a transplant tomorrow that the transplant system is safe," said Millis, who supports use of the newer test. "Can we do better? I think we can."

I couldn't imagine what I would do if something like this happened to me or someone I know.

**sunnykerr** · 11-13-2007, 09:47 PM

Well, it happened to someone I know. But that was in the '80s. He had open heart surgery at 11 months and the blood was contaminated and he died of AIDS before his 13t birthday. And that (and other cases such as his) is why we no longer have the Red Cross in Quebec (and, possibly, the rest of Canada, but I'm not sure about that).

Because people in charge of these things should run the tests that need to be run. And, barring that, should tell the families and the individuals on the receiving end of organ donation and blood transfusions that, though potentially lifesaving, the gift they're signing up for might be a lemon.

**sum1** · 11-15-2007, 08:17 AM

If there's a test that can detect the virus earlier, they should be using it. Costlier or no. Maybe they should be using both tests. It's not like this isn't serious stuff deserving of all measures.

elisheva · 11-15-2007, 10:35 AM

That's so scary - to think you're getting a potentially life-saving transplant and to end up with a life-threatening illness instead.

Patients definitely deserve more information and greater assurance that the blood or transplant they're receiving is safe.

abw92 · 11-16-2007, 07:55 AM

There should definately be tests done before the transplant. I couldn't imagine how the patients feel.

4N6 DNA · 11-16-2007, 01:42 PM

Wow, that is a shocking article. Condolences to the families that have to go through that ordeal. The first thing I want to do is blame the hospitals. But in reality we can't. Tests that detect hepatitis and HIV can take 3-30 weeks to show up after someone is infected with the virus. And organ donation isn't something that can wait that long. Hearts and lungs wont last more than 4 hours for example. And with all the paperwork involved, it adds to the difficult. And its hard to do the checks that deem organ donation 100.00% safe, with the rush of the patients needs. They weigh that with the very slim chances of contracting HIV via infected organs, apart from these cases. But alas, this does not make the story any less heartbreaking

sunnykerr
I am sorry to hear about the guy you knew. Such unfortunate circumstances

Quote:

Originally Posted by sum1 (View Post)

If there's a test that can detect the virus earlier, they should be using it. Costlier or no. Maybe they should be using both tests. It's not like this isn't serious stuff deserving of all measures.

There is a test like that for blood and tissue donations called a Nucleic Acid Amplification Test (NAAT). It detects viruses in the system directly. It is more accurate and much faster way of finding a virus in the system. It is FDA approved and many centers use it in conjunction with other tests, but it is not required and many donation centers on a budget simply bypass this step.

Hopefully in the near future, science can find a way to make organ transplant entirely safe for the patient. That will be a miraculous discovery.

Thank you for sharing that article FieryAngel.

elisheva · 11-17-2007, 12:23 PM

Thanks so much for that perspective, 4N6 DNA. It makes sense.

Is the NAAT very expensive?

NYCity Boy · 11-17-2007, 03:17 PM

jessie could you explan how the tests are different? how could that other process detect something others couldnt? And what about the current testing centers is making the process inaccurate?

and if you dont mind, please start with the basics, my biology knowledge is minimal to )

I am so curious because my 8 year old niece got HIV from a blood donation.

4N6 DNA · 11-17-2007, 03:54 PM

Sorry to hear about your niece Orlando

To answer your questions.

The most used procedure to detect HIV is through what is called an antibody test. When the virus HIV enters someones bloodstream, the body will produce what are called antibodies, which is the natural response to the infection. This particular antibody test tests for these in the blood. If you have the antibodies, you have the infection. The only exception to this is a new baby born from a HIV positive mother.

It takes between 1.5 - 3 months for the antibodies to show up in the blood, that is why they ask you to wait 3 months before you get tested. This also contributes to the donation problem. What if an organ doner dies and is tested for HIV before the 1.5 months it will take the antibodies to show up? No antibody test can avoid this problem. Also, the few people with longer term HIV infection can have a false negative antibody test and can show up clinically asymptomatic. So you wont know in this case either.

The NAAT testing avoids all this becasue it tests your genetic material with a Polymerase Chain reaction (PCR) test instead of your blood. It can detect HIV in your blood within 2 weeks of infection (as opposed to 3 months from the antibody test) and it only takes about 2 hours to do (as opposed to the 1-2 days at the antibody test). It isn't perfect (a test which could detect a virus immedietly after infection would be perfect) but it is certainly a more exact and faster process. This method is also a lot less evasive (urine tests instead of drawing blood) so more people would prefer it. Another positive is that not only will it tell you if you have the virus, it will tell you to what extent you have been infected. The downside of the test is that it is mroe complicated to administer and a lot more costly. They are mostly avaliable in private clinics for people willing to pay.

In one study performed in Atlanta, 6% of the HIV positive people were missed using the standard antibody procedure but detected by the NATT procedure. With something like HIV, that is too much.

I hope this helps you.

elisheva
I don't know know the exact costs, but it is significatly higher by many folds. The regular testing method simply involves growing a culture of someones bacteria in a lab. This really costs almost nothing but time. Witn NAAT you need a PCR machine, which costs many thousands of dollars. My university just aquired one for half a million dollars

NYCity Boy · 11-17-2007, 04:13 PM

wow thanks for explaining that so well jessie.

Quote:

Originally Posted by 4N6 DNA (View Post)

If you have the antibodies, you have the infection. The only exception to this is a new baby born from a HIV positive mother.

hows this possible? do you mean to say any woman infected with HIV will pass it to their children and they will have it? And you wont know if they have it for sure? Seems crazy, Maybe I am misinterpreting it

4N6 DNA · 11-17-2007, 04:33 PM

Babies retain their moms antibodies for about a year and a half after they are born. So if the mother has HIV and she has the anitbodies for HIV in her system, the baby will as well, for that timeframe. And if the baby were to take an HIV or blood test during that time frame, it will turn up positive for HIV, even if she does not have it. That is why when a child is born from an HIV positive mother, they get a PCR test

That doesn't matter what is in the blood.

As for HIV in pregnant women, HIV can be transmitted from a mother to her baby in a few ways. During the actual pregnancy, during the delivery or even breastfeeding. The chance is around 30%. But there antiretrociral drugs that women can take to lower that to about 2%.

It is a pretty complex and an intense combination treatment process. The treatment includes AZT, certain drugs at the first trimester and then monotherapy, Nevirapine and it could go on. Sadly, that is why it isnt done a lot of times with women who can't afford it. More and more children are being born with HIV, it isn't fair.


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