A transplant patient in New York has contracted the AIDS virus from the kidney of a living donor, the nation’s first case of transmission from a living organ donor since screening for HIV began in the mid-1980s, the New York State Department of Health said on Thursday.
The donor had unprotected gay sex in the 11 weeks between the time he tested negative for the AIDS virus and the time the surgery took place in 2009, according to a report issued Thursday by the U.S. Centers of Disease Control and Prevention.
The health agency said it recommends that organ donors have repeat HIV tests one week before surgery.
“The most sensitive test needs to be done as close as possible to the time of transplant,” said Dr. Colin Shepard, who manages the tracking of HIV cases for the New York City Health Department.
The CDC also said potential organ donors should be advised to avoid behavior that can increase their chances of infection.
Although living organ donors in the U.S. are routinely tested for infectious diseases such as hepatitis and HIV, the organization that oversees organ transplants does not have a clear policy on when such screening should occur. Instead, that decision is left to the transplant centers.
Patient confidentiality rules prevented health officials from releasing many details about the donor, recipient, their relationship or the hospital where the transplant took place, except to say that it was in New York.
Neither the donor nor the recipient was aware of their infections until a year after the transplant, the CDC report said.
Health officials said that the transplant recipient developed AIDS, perhaps due to drugs taken to suppress the immune system to prevent organ rejection, while the donor did not.
Both are receiving treatment.
“We don’t know how frequently this is happening and we need better surveillance,” said Dr. Matthew Kuehnert, co-author of the CDC report.
HIV infections in a donor or recipient may not be discovered until long after the transplant occurred. In this case, once health authorities were notified of the AIDS infection late last year, they spent months investigating whether the transplanted kidney was the source. Genetic analysis of the virus confirmed that the infection had originated in the donor.
There has been one confirmed report since the 1980s of a deceased donor’s organs spreading the AIDS virus to a recipient. That case involved organs from a 38-year-old gay man that went to four recipients in 2007.
For years, transplant organizations focused mainly on screening organs taken from the dead donors, which accounted for the vast majority of transplants. But kidney transplants from live donors are becoming increasingly common. Indeed, while just 32 percent of kidney transplants came from live donors in 1988, that number had grown to more than 46 percent by last year, according to federal government data. Donors are typically relatives or friends.
Some 88,000 people are currently on the kidney waiting list, according the United Network for Organ Sharing, a nonprofit group that oversees the United States’ organ transplant system for the federal government.
The organization is currently developing new policies for live donors, according to spokesman Joel Newman.
Transplant centers employ teams that evaluate potential donors and search for physical or psychological problems.
CDC officials recommend a more sensitive HIV test be used, which can detect the virus within 10 days after a person is first infected. However, the traditional test, which does not detect HIV antibodies until three to eight weeks after infection, is more commonly used.
The CDC report can be viewed at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6010a1.htm?s_cid=mm6010a1_w
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