Four Transplant Recipients Contract H.I.V

							     Four Transplant Recipients
           Contract H.I.V.
                By DENISE GRADY
                  New York Times
           Published: November 14, 2007

http://www.nytimes.com/2007/11/14/health/healthspecial/14hiv.html?ref=health
            H.I.V. from a Donor
• Four transplant recipients in Chicago have contracted
  H.I.V. from an organ donor, the first known cases in
  more than a decade in which the virus was spread by
  organ transplants.
• The organs also gave all four patients hepatitis C, in
  what health officials said was the first reported instance
  in which the two viruses were spread simultaneously by
  a transplant.
• Though exceedingly rare, this type of transmission
  highlights a known weakness in the system for checking
  organ donors for infection: the most commonly used
  tests can fail to detect viral diseases if they are
  performed too early in the course of the infection.
  Officials say the events in Chicago may lead to
  widespread changes in testing methods.
 Most likely kidneys, liver and heart or lungs

• Officials would not say what organs were transplanted, but a
  transplant expert not connected with the case said they were most
  likely the kidneys, liver and either the heart or lungs. Only four
  organs, and no other tissue, were taken from the donor.

• The University of Chicago said that the operations took place in
  January, and that the donor was an adult who died in an Illinois
  hospital “three days after traumatic injury.” Neither the donor’s age
  nor sex were disclosed. The other hospitals declined to discuss
  what happened, except to confirm that each had an infected patient.

• The situation came to light earlier this month when one of the
  recipients, who was being evaluated for a retransplant, tested
  positive for H.I.V. and hepatitis C. At that point, blood preserved
  from the donor was given a highly sensitive test for viruses, and the
  infection was found.
          Was the test too recent?
• Initially, the donor had tested negative for H.I.V. and hepatitis C,
  apparently because the infection was too recent to be detected by
  commonly used blood tests. Those tests do not find the virus itself,
  but instead look for the body’s reaction to the infection — the
  antibodies produced by the immune system. But the body takes
  time to react, and if the test is done too soon, within 22 days of
  H.I.V. infection or 82 days for hepatitis C, antibodies may not yet be
  detectable.
• Doctors say that is what probably occurred in Chicago. It has
  always been known that this kind of transmission was theoretically
  possible, but it was considered highly unlikely. And indeed, since
  1994 nearly 300,000 transplants from cadavers have occurred
  without any reported cases of H.I.V. transmission.
                  The Naat Test
• Another more sensitive type of test can pick up viral
  infections earlier, but was not used. That test looks for
  evidence of the virus itself, and can reduce the “window,” the
  early period in which the test does not work, to 12 days for
  H.I.V. and 25 days for hepatitis C.
• That test, the nucleic acid amplification test, or Naat, is not
  widely available, and doctors said it was more difficult and
  time-consuming than other tests — and there is usually no
  time to spare with transplants because organs deteriorate
  quickly when the donor dies.
• Another concern is that the test is more likely than others to
  give false-positive results, and lead to the needless
  destruction of healthy organs, a scarce resource.
• Dr. Robert Brown, director of the liver transplant program at
  NewYork-Presbyterian/Columbia said, “There is always a
  drive toward better testing, but if it leads to more organ
  wastage, we’ll probably hurt more people than we help.”
       Very Simple Economics
                                         MB    MB'            MC'
• We don’t use a market for    New$
                               “Price”
  organ donation, so some      with a
                               market                           MC
  with MB > MC may not get
  organs, and others with      “Price”
                               with a
  MB < MC may get them.        market




• But you still may see
  increasing costs, if you
  have to do more tests,
  and you may throw away
  useful organs in the event
  of false positives.
                                              O2 O1
                                                # of organs