Shapiro, a member of the ethics panel for the United Network for Organ Sharing, a private, nonprofit organization under contract with the federal government to manage the nation's organ transplant system, acknowledged that because of organ shortages, transplant centers have increasingly turned to living donors from groups considered high-risk for HIV, which generally has been gay men. "We have told those people -- or at least asked -- that they not engage in any potential high-risk behavior between the time of their last negative test and the time of their donation. That seems only prudent."
Shapiro said that with living donors, "it's not a bad recommendation that we tighten up screening," even if the overall risk of spreading HIV through a living organ donation is small.
Kuehnert said that if the CDC recommendations are widely adopted, some cases of HIV still will be spread via living donors. "There always will be risks because organs can't be sterilized," he said. "That's why it's so important for living donors to understand that if they have high-risk behavior, no matter what test they do, it's possible the test will not pick it up." Similarly, he said, all potential transplant recipients should be counseled that despite the more sensitive donor screening, "a very small risk remains that they could acquire HIV or other infections as a result of transplantation."
In an interview Thursday, Hutton said the New York case only came to light recently. "It took us a while to trace the cause."
She said that after the transplant, the recipient was hospitalized several times for what doctors suspected was rejection of the transplanted kidney. During the year after the transplant, the recipient developed yeast infections of the mouth and esophagus that didn't respond to treatment. Such yeast infections are often associated with HIV infection. HIV tests came back positive, and the patient had a low CD4 cell count, an indication of a weakened immune system that likely resulted from immune-suppressing drugs prescribed to prevent rejection of the transplanted kidney.
When doctors inquired about the patient's risk for HIV, they found no history of sexually transmitted infections, injection drug use, sex with injection drug users or other high-risk sexual activity. The patient had received blood transfusions in 2006, but none before that, and had tested negative for HIV 12 days before the transplant operation.
Investigators then began looking more closely at the donor, who met eligibility criteria of being a generally healthy, willing donor whose blood and tissues were compatible with those of the intended recipient.
A routine evaluation six months after the transplant found him to be HIV-negative, although when he asked his own doctor to re-test him for sexually transmitted infections a year after his donation, he tested HIV-positive, the CDC report said. The transplant team learned of his HIV infection during a follow-up visit a year after the transplant.
The HIV diagnoses of both donor and recipient "raised the possibility of transplant-transmitted HIV infection," the CDC said, and led New York City health authorities to launch a public health investigation that revealed the donor had unprotected sex with a male partner during the year before the transplant, "including the time between his initial evaluation and organ recovery. He did not know his partner's HIV status."