March 17, 2011
The New York State Department of Health is recommending a shorter HIV and hepatitis screening window and nucleic acid testing (NAT) for living organ donors following a recent HIV transmission from a kidney donor to a recipient in New York City. The advisory also urges hospitals to question living donors about risky behaviors, including injection drug use.
This is the first documented case of HIV transmission by way of a live-donor transplant since improvements in the screening process were initiated in 1985, said a health department spokesperson.
The hospital, which, in the interest of patient privacy, the spokesperson declined to identify, followed appropriate protocols in screening the kidney donor. However, the donor apparently had unsafe sex after testing and before surgery to harvest the organ. "Of course this is a rare case, but we felt like we needed to alert centers to this possibility so they can talk to potential donors about risks and do testing closer to the time of surgery," the spokesperson said.
The advisory calls for HIV and hepatitis B and C testing to be performed within 14 days of living-donor donation using NAT, which can detect virus antibodies weeks to months before standard blood tests. NAT is not recommended for organs from deceased donors due to time constraints, as organs soon begin to deteriorate.
Infectious disease screening has virtually eliminated HIV transmission through donated organs, blood or tissue. CDC's most recent HIV-specific organ donation screening recommendations were issued in 1994; updated guidelines from the agency are expected this year.