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Transplant Patients Contract HIV

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By DENISE GRADY, The New York Times

Published: November 14, 2007

Four transplant recipients in Chicago have contracted HIV from an organ donor, the first known cases in more than 20 years of the virus being spread by organ transplants. The organs also gave all four patients hepatitis C, in what health officials said was the first reported instance of the two viruses being spread simultaneously by a transplant.

Although 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.

"There are important policy implications," said Matthew Kuehnert, director of the Office of Blood, Organ and Other Tissue Safety at the federal Centers for Disease Control and Prevention, which is investigating the incident. "Clearly the organ transplant community is going to think about the issues raised by this, and we look forward to being involved in those discussions."

The cases were first reported Tuesday by the Chicago Tribune. Two patients were infected at the University of Chicago Medical Center, and one each at Rush University Medical Center and Northwestern Memorial Hospital. The transplants were coordinated by an organization called the Gift of Hope of Elmhurst, Ill.

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 Centers for Disease Control and Prevention is investigating the case. The situation came to light earlier this month when one of the recipients, who was being evaluated for a retransplant, tested positive for HIV and hepatitis C. At that point, blood preserved from the donor was given a highly sensitive test for viruses, and the infection was found. J. Michael Millis, the chief of transplantation at the University of Chicago, said the patients were devastated, and the doctors heartbroken. He said the diseases were treatable.

Initially, the donor had tested negative for HIV 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 HIV 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. The CDC thinks the infections are the first instances of HIV transmission via infected organs since a North Carolina case in 1986. Since 1994 nearly 300,000 transplants from cadavers have occurred without any reported cases of HIV transmission.

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