Transplant Docs Change Practice After HIV Case

Jan. 17, 2010— -- After a rare, high-profile case of HIV transmission through organ transplant, nearly a third of surgeons changed their practice, researchers reported.

But the most common change was to avoid the use of high-risk donors, rather than to institute better ways of detecting the virus before transplant, according to Dr. Dorry Segev and colleagues at the Johns Hopkins University School of Medicine.

The finding, from a survey of more than 400 transplant surgeons, suggests that fear of legal or regulatory consequences -- rather than patient safety -- was driving changes in practice, Segev and colleagues reported in the January issue of Archives of Surgery.

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In 2007, transplants from a single high-risk donor transmitted both HIV and hepatitis C to four organ recipients, despite negative antibody tests before the procedures. The case made national headlines, Segev and colleagues noted, and sparked a debate about informed consent and testing for HIV.

One of the issues was the use of the antibody test for HIV and hepatitis C, which in the first weeks after infection -- 22 days for HIV and 82 for hepatitis C -- cannot detect the presence of the viruses.

After the discovery of the transmission, physicians retrospectively used nucleic acid testing -- which reduces the discovery window to nine and seven days for HIV and hepatitis C, respectively -- and confirmed the donor had been infected.

To see what effect the case had, Segev and colleagues surveyed transplant surgeons across the U.S. between Jan. 17, 2008, and April 15, 2008, getting responses from 422 surgeons in current practice.

Of those, they found, 297 reported using high-risk donors, but 31.6 percent of surgeons changed their practice after the 2007 event. Forty-one percent of those who changed decreased their use of high-risk donors.