Chicago Tribune - November 14, 2007
Jeremy Manier, Tribune staff reporter

The four patients contracted HIV and hepatitis C from an infected donor in January and did not know of the potential risk to their partners and close contacts until they tested positive for the diseases in the last two weeks. The infected donor had not tested positive for the diseases, likely because the infections were too recent to register on screening tests, officials believe.

The risk to others could have been reduced had the hospitals tested the organ recipients soon after their transplants, said Dr. Matthew Kuehnert, director of blood, organ and tissue safety with the federal Centers for Disease Control and Prevention. Kuehnert said he was concerned that none of the affected hospitals -- Rush University Medical Center, Northwestern Memorial Hospital and the University of Chicago Medical Center -- appeared to have followed CDC guidelines for testing at-risk patients after a transplant.

Although investigators have established that no one else got contaminated organs or tissue from the donor, it's too soon to say whether the organ recipients passed on the infections to anyone else, Kuehnert said.

"That's part of the public health investigation," Kuehnert said. "It's something that we're concerned about and we're asking questions about through the [Chicago] Health Department."

A spokesman with the city's Department of Public Health said the investigation is ongoing, and there is no evidence to suggest that the organ recipients have spread the disease.

The organ donor had engaged in high-risk behavior, officials said, meaning that the transplant recipients should have been tested for HIV three months after their operations, even though the donor's initial HIV test was negative. That three of Chicago's biggest hospitals failed to follow the CDC testing recommendations after the transplants may suggest that few institutions took the risk of transmission seriously enough before now, Kuehnert said.

"It's hard to know how often recipients who get organs from high-risk donors are tested," Kuehnert said. "I don't see a downside to testing."

The cases have reopened the issue of how to protect organ recipients from disease while ensuring that they get needed transplants, federal officials said. Many experts believe the infections show that organ programs should follow the lead of blood and tissue banks, which employ more extensive screening procedures that have less chance of giving inaccurate results.

Most organ banks use tests that detect antibodies for HIV and hepatitis, which can take anywhere from three weeks to several months to show up on a test after an individual has been infected. But blood and tissue banks use those tests as well as a test called NAAT, which detects a virus' genetic material directly. Such genetic tests can accurately find a virus much closer to the time of infection.

Yet applying such techniques to organ donation may be difficult.

For example, blood banks typically take a day or two to process blood donations through a full battery of tests for diseases, said Dr. Ram Kakaiya, medical director for the Glenview-based LifeSource blood center. Because blood and tissue can be stored, the banks can wait while large batches are sent out for testing.

In contrast, organs can be stored only for a short time -- as little as four hours in the case of hearts and lungs, experts said. That makes it more difficult to test the organs in large batches, said Dr. James Burdick, head of the division of transplantation at the federal Health Resources and Services Administration, which oversees the national organ donation system. Burdick said he would like to see organ procurement programs adopt the genetic testing methods over time.

"I predict it will happen. We're just not there today," Burdick said. "I hope it won't be too long ... maybe a year or two."

Yet Burdick also said, "In the big picture the risk of obtaining a disease is a very small part of the picture for someone who needs an organ. The chances of acquiring HIV from a donor are vanishingly small, and this one case doesn't prove differently."

The CDC believes that the Chicago infections are the first instances of HIV transmission via infected organs since a North Carolina case in 1986. (Officials with the United Network for Organ Sharing had said Monday that the last case was in 1985, but on Tuesday a spokesman for the group said the CDC date is correct.)

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jmanier@tribune.com

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