ATLANTA (AP) — A transplant patient contracted AIDS from the kidney of a living donor, in the first documented case of its kind in the U.S. since screening for HIV began in the mid-1980s.
It turns out the donor had unprotected sex in the
11 weeks between the time he tested negative and the time the surgery took
place in 2009.
In a report Thursday on the New York City case, the
Centers for Disease Control and Prevention recommended that organ donors have
repeat HIV tests a week before surgery.
"The most sensitive test needs to be done as
close as possible to the time of transplant," said Dr. Colin Shepard, who
oversees tracking of HIV cases for the New York City Health Department.
The CDC also said would-be organ donors should be
told to avoid behavior that can increase their chances of infection.
Living organ donors in the U.S. are routinely
tested for infectious diseases such as hepatitis and HIV. But the organization
that oversees organ transplants in the U.S. does not have an explicit policy on
when such screening should be done. That's left up to transplant centers.
Because of patient confidentiality, health
officials released few details about the donor, recipient, their relationship
or the hospital where the transplant took place, except to say that it is in
New York.
Neither the donor nor the recipient knew he or she
had HIV until about a year after the transplant, according to the CDC report.
The recipient developed AIDS, perhaps because he or
she was on drugs that suppress the immune system to prevent organ rejection,
while the donor did not, health officials said. Both are receiving HIV
treatment. Their conditions were not disclosed in the report.
"We don't know how frequently this is
happening and we need better surveillance," said Dr. Matthew Kuehnert, a
CDC official who co-wrote the report.
HIV infections in a donor or recipient may not be
discovered until long after a transplant, and even then, patients and their
doctors may not make the connection and report it, health officials said.
In this case, once health authorities were notified
late last year, they spent months investigating whether the transplanted kidney
was the source of the patient's AIDS infection. Genetic analysis of the virus
confirmed investigators' suspicions.
At least one similar U.S. case has been reported in
the media. An Orlando, Fla., woman last year filed a lawsuit saying she was
infected with HIV through a 2007 kidney transplant from a live donor in
Florida. However, CDC officials said they have not been asked to investigate
and could not confirm the report.
Before that, Italian doctors reported HIV
transmission from a live organ donor in 1989.
Since the 1980s, there has been a confirmed report
of a deceased donor's organs spreading the AIDS virus. That happened in
Illinois in 2007, when organs from a 38-year-old gay man went to four
recipients.
For many years, transplant organizations focused
heavily on screening organs taken from the dead, which accounted for the large
majority of transplants. But kidneys from live donors are becoming increasingly
common. In 1988, about 32 percent of kidney transplants came from live donors.
By last year, it was more than 46 percent, according to federal data. Donors
generally are relatives or friends.
About 88,000 people are on the kidney waiting list
right now, according the United Network for Organ Sharing, a nonprofit
organization that manages the nation's organ transplant system for the federal
government. The group is developing new nationwide policies for live donors,
spokesman Joel Newman said.
Transplant centers have teams that evaluate
potential donors and look for physical or psychological red flags. But some
would-be donors may find themselves in a quandary: They want to save a loved
one's life but are unwilling to reveal that they use drugs, have gay sex or
engage in other behavior that raises their risk of HIV.
Some donors may assume they will be tested for
every important kind of infection, and think it doesn't matter whether they
disclose their risky behavior, Kuehnert said.
CDC officials recommend a HIV test developed in the
1990s that is more sensitive than traditional testing. The more sensitive test
can detect HIV within 10 days after the person is first infected. An older test
won't detect antibodies to HIV until three to eight weeks after infection. Yet
the older tests are more commonly done.
Copyright
2011 The Associated Press.
