Organ donors should be screened for HIV within a week of the operation, the federal Centers for Disease Control and Prevention recommended Thursday. The call came after the first documented U.S. case of HIV spread by a living donor -- a man who tested negative 10 weeks before a sick patient got his kidney.
The recipient, a kidney failure patient on hemodialysis, contracted HIV months after receiving a kidney from a man who tested negative at his initial screening, but subsequently engaged in unprotected sex, said Claudia Hutton, director of public affairs for the New York State Department of Health in Albany. Her department, along with New York City's Department of Health, conducted a public health investigation because the 2009 transplant took place at a New York City hospital, which she declined to identify. However, she said the hospital had followed the necessary protocols. All agencies involved in the investigation have declined to provide the recipient's gender because of privacy concerns.
On Monday, New York health officials issued interim recommendations calling for hospital administrators, organ transplant directors, and transplant coordinators to follow up initial blood tests for HIV, hepatitis B and hepatitis C with repeat testing. They recommended using more sensitive testing, called nucleic acid testing, which can detect these viruses within 8 to 10 days. That is well before the immune system responds to the virus by developing antibodies, typically 3 weeks to 8 weeks after exposure.
The state health agency said the additional tests should be performed "no longer than 14 days preceding organ donation" and recommended that potential living donors receive counseling to avoid unprotected sex and injection drug use, which could place them -- and the recipient -- at risk for HIV and hepatitis between the initial screening and the time the organs are transplanted.
"That's our advice, it's not a mandate," Hutton said. Asked about the CDC's recommendation for testing "close to the time of organ recovery as logistically feasible, but no longer than 7 days before organ donation," she said, "We think that there will need to be broad national discussion in the medical community on this before a consensus is reached on what the outside limit of days should be."
"The shorter the time period, the better, but you have to be realistic," said Dr. Elizabeth Donegan, a professor of clinical anesthesia at the University of California, San Francisco, who directed a landmark, federally funded study examining transmission of HIV and other infections through blood transfusions.
Donegan said that UCSF flies blood samples overnight to a laboratory in Phoenix for nucleic acid testing. "It takes a while to do the test, and if there's a false positive, you have to do it again. That being said, a week is realistic, 10 days, two weeks -- as long as it's reasonably close."