Risk of Donor Disease Transmission in Transplantation

Matthew J. Kuehnert, Center for Diseases Control and Prevention, Atlanta, GA, USA.

This presentation will include review of recent transmissions through organ transplantation and lessons learned, including transmission from deceased and living donors; preliminary results of a study which estimates the yield of nucleic acid testing (NAT) for organ donor screening; plans to revise the current Public Health Service (PHS) Guidelines for reducing HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) through solid organ transplantation; and identification of knowledge gaps in organ transplant safety, highlighting the need for prospective data collection to improve risk estimates and inform the effectiveness of current policies. Donors should be risk managed from the standpoint of disease transmission to provide the best possible benefit for recipients. This process includes the use of an organ donor screening through epidemiologic and laboratory methods, and recipient informed consent and post-transplant testing.

A standardized and transparent donor screening and recipient evaluation process is particularly critical for relatively new life-enhancing procedures, such as vascularized composite allografts. PHS Guidelines are being revised to assess donor risk through these methods and appropriate recipient evaluation, including the use of NAT. However, there are also research gaps, including the need for better models to estimate risks of false positive tests and other threats to optimal organ placement. Structured databases on donor and recipient results are key, allowing for development of the best risk communication and informed consent.