Four Transplant Recipients Positive For HIV and Hepatitis C

This is truly a tragic case with widespread implications. A single organ donor has apparently transmitted the HIV virus AND the hepatitis C virus to four organ recipients.

The nation's blood supply is quite safe because very accurate PCR testing detects almost unimaginably low levels of the HIV virus. However this test is NOT used for organ transplants and the ELISA test is used instead. The ELISA is not nearly as sensitive and can miss early infections (i.e. infections only a few weeks old).

This may seem crazy but, and I don't have more information about this yet, my sense is that the PCR test takes much longer to do and the added time may be unacceptable in the setting of transplant surgery. If this is the case, it would appear that this cannot be held against the transplant team(s).

However, the University of Chicago which performed the transplants does not appear blameless in this. The CDC has a policy advising that "high risk" donors (those who engage in behaviors strongly associated with HIV or hepatitis infection such as male/male homosexuality, unprotected promiscuous sex, intravenous drug use, etc.) should NOT be considered unless the recipients are gravely ill. Apparently the preliminary paperwork suggests that this donor did indeed fall into one or more of these categories. This will surely be looked at in more detail soon along with the recipients' actual acuity.

The assay for the hepatitis C virus has similar constraints as that for HIV. The more accurate quantatative test takes much longer to do than the relatively rapid antibody test.

My guess is that this event is going to open up a tremendous market for PCR or other gene amplification assays for both HIV and hepatitis viruses that are fast enough to be used for transplants. Development efforts should be immediately spurred by this.

Rightly so, and to everyone's benefit.