Dr. Hans Gritsch, right, prepares a donated kidney as another team prepares… (Spencer Weiner/Los Angeles…)
In November 2007, four organ transplant recipients in Chicago contracted HIV and hepatitis C from a deceased "high risk" organ donor.
It was a nightmare scenario, to be sure, but it was also an extreme rarity: the first documented case of HIV transmission through an organ transplant in more than 20 years.
Still, the ripple effect for surgeons who perform organ transplants has been significant, according to a study published Monday in the journal Archives of Surgery . Nearly a third of 422 practicing transplant surgeons surveyed by a Johns Hopkins research team in early 2008 changed the way they evaluate organs from "high risk" donors as a result of the 2007 incident, they reported.
While it's great that surgeons are aware of risks and take appropriate precautions, the researchers suggest, they might not be making changes to policy that help patients most. Rather, most of the adjustments made could have been considered "defensive medicine" -- moves designed to protect the surgeon, who might fear getting sued, rather than transplant patients, who desperately need donor organs.
For example, 41.7% of the surgeons who said they changed their practices reported decreased use of high-risk donors. An additional 31.6% said that they ramped up their emphasis on informed consent -- getting patients to assume responsibility for unlikely complications.
But different types of changes might have better served patients. In the 2007 case, the donor's antibodies tested negative for HIV and hepatitis C, but later nucleic acid testing was positive, which means that the donor may have died during what is called the "window period" between infection and detectability. Increased use of nucleic testing could have flagged the organs in time, making it unnecessary to turn away all organs from high-risk donors at a time when organs are in such short supply.
The Hopkins team wrote that the chance of getting HIV or hepatitis C from a high-risk organ is not much higher than the risk of acquiring either disease while awaiting transplant. More than 8% of organ donors are high-risk.
"Given the severity of the organ shortage and high incidence of waiting-list mortality, centers should strive for appropriate rather than decreased use of high risk donors," the team wrote.
Related: Chicago Tribune, Four transplant recipients get HIV from donor.