2013 - ISODP 2013 Congress


Oral Presentation 6 on Deceased Donor Management

13.6 - Organ donor screening by serology and NAT allows immediate diagnosis of blood-borne viruses and safer use of organs from increased risk donors

Presenter: Cristina, Baleriola, Randwick, Australia
Authors: Cristina Baleriola, Chee Choy Kok, Sanghamitra Ray, Peter Robertson, William Rawlinson


Organ donor screening by serology and NAT allows immediate diagnosis of blood-borne viruses and safer use of organs from increased risk donors

Cristina Baleriola2, Chee Choy Kok1, Sanghamitra Ray3, Peter Robertson4, William Rawlinson5

1Microbiology, South eastern Area Laboratory Services, Randwick, Australia, 2Microbiology, South Eastern Area Laboratory Services, Randwick, Australia, 3Microbiology, South eastern Area Laboratory Services, Randwick, Australia, 4Microbiology, South Eastern Area Laboratory Services, Randwick, Australia, 5Microbiology, South Eastern Area Laboratory Services, Randwick, Australia

Serology and nucleic acid test (NAT) screening for HBV, HCV and HIV are key steps to prevent blood-borne-virus (BBV) transmission from organ donors. We assessed optimal use of NAT in the solid organ transplant setting for 4 years through evaluation of requests and results for NAT and serology testing in routine and increased risk donors (IRD).

 

Review of NAT and serology results for donor screening from October 2009 to July 2013 showed NAT was performed on a total of 422 donors; 100 performed prospectively while 322 performed retrospectively. There were 295 organs (3.0 organs/donor) retrieved from IRD and 1,121 organs retrieved from 322 average-risk donors (3.5 organs/donor).

 

NAT screening of 42 serology positive (1 HIVAb+, 11 HCVAb+, 30 HBV HBcAb or HBsAg+) donors resulted in transplantation of 67 additional organs that without NAT screening would either have not been used or used with restrictions. The NAT assays demonstrated the HIV donor was NAT positive, the HCV donors were 9/11 NAT positive, and the HBV donors were 3/30 NAT positive. Of the HBV donors, 27/30 were HBcAb positive and 0/27 NAT positive, and 3/30 HBsAg with 3/3 NAT positive. Donors accepted for transplantation were HIV 0/1, HCV 3/11 (all of whom were NAT positive and transplanted into HCV RNA positive recipients) and 19/27 HBcAb positive donors transplanted. Most transplanted organs with positive serology and negative NAT were from HBcAb positive donors (n=19 donors with 63 organs transplanted) and 4 organs retrieved from 3 HCV positive donors.

 

The availability of a 24/7 NAT screening service for organ donors provides diagnosis within 8 hours of blood delivery. This enabled the use of organs from donors with positive serology but inactive viral infection and donors with false positive serology results. This algorithm allowed use of organs from IRD with safer expansion of the donor pool.


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