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• W1573918526 abstract "To the Editor: In their analysis of undetected human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections among potential organ donors, Ellingson et al. conclude that nucleic acid testing (NAT), in addition to enzyme immunoassays (EIA) as is currently required by Organ Procurement and Transplantation Network (OPTN) policy (1Ellingson K Seem D Nowicki M Strong DM Kuehnert MJ for the Organ Procurement Organization Nucleic Acid Testing Yield Project TeamEstimated risk of human immunodeficiency virus and hepatitis C virus infection among potential organ donors from 17 organ procurement organizations in the United States.Am J Transplant. 2011; 11: 1201-1208Abstract Full Text Full Text PDF PubMed Scopus (76) Google Scholar) would significantly reduce undetected HCV infection, but due to limitations of the data, are equivocal regarding a similar addition of NAT screening for HIV. However, their data are derived from deceased potential donors only and the risk estimates may require separate modeling for living donors. Although the OPTN has oversight of living and deceased organ donors, there are few policies specifically for living donation, and none that specify the type and timing of HIV screening prior to transplant (2Organ Procurement and Transplantation Network. Guidance for the development of program specific living kidney donor medical evaluation protocols. Available at: http://optn.transplant.hrsa.gov/ContentDocuments/Guidance_ProgramSpecificLivingKidneyDonorMedEvalProtocols.pdf. Accessed September 6, 2011.Google Scholar). Our recent investigation of HIV transmission attributable to living donor kidney transplantation demonstrated the need for more effective pretransplant screening of living donors and risk behavior counseling (3Centers for Disease Control and PreventionHIV transmitted from a living organ donor—New York City, 2010.Morb Mortal Wkly Rep. 2011; 60: 297-301PubMed Google Scholar). The donor screened HIV negative by EIA 79 days pretransplant and acquired HIV after screening but prior to transplantation; repeat screening was not performed prior to transplantation. With increasing numbers of living donors, establishment of best practices specifically for living organ donation is long overdue. OPTN policies should be revised to clearly distinguish deceased donors, necessitating immediate pretransplant screening, from living donors who may acquire HIV and other infections after screening. Transplant centers and OPTN should consider the following interventions to reduce the risk and morbidity of living donor HIV transmission: first, screening with HIV NAT and EIA should be performed as close to the time of organ donation as possible (3Centers for Disease Control and PreventionHIV transmitted from a living organ donor—New York City, 2010.Morb Mortal Wkly Rep. 2011; 60: 297-301PubMed Google Scholar,4Centers for Disease Control and Prevention. PHS guidelines for reducing transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) through solid organ transplantation. US Department of Health and Human Services, HHS, Rockville, MD. Available at: http://www.ofr.gov/OFRUpload/OFRData/2011--24189_PI.pdf. Accessed on September 22, 2011.Google Scholar). Second, all potential donors should be counseled that they can acquire HIV and other infections between screening and donation; counseling should include written documentation and explicitly state behaviors to be avoided. Third, although there is limited evidence, routine screening of organ recipients for HIV posttransplant, irrespective of donor risk factors, should be considered. Implementing these recommendations may be hindered by concerns regarding their potential cost and complexity. While HIV EIA screening costs < $100, costs for HIV NAT vary but are often <$1000 and can be significantly reduced if specimens are pooled. Although cost-effectiveness of HIV NAT for living donor screening has not been evaluated, it has been shown to be cost-effective in other public health settings (5Pilcher CD Fiscus SA Nguyen TQ et al.Detection of acute infections during HIV testing in North Carolina.N Engl J Med. 2005; 352: 1873-1881Crossref PubMed Scopus (311) Google Scholar). Ultimately, the relative cost of HIV NAT compared to organ transplantation or the cost of lifetime HIV treatment is low. The lack of specific OPTN policies for living donors is an important public health gap and establishment of standardized policies would simplify the screening and evaluation process at transplant centers. With increasing numbers of living donors, policies and best practices specific to living donors should be developed. The authors of this letter have no conflicts of interest to disclose as described by the American Journal of Transplantation. The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention." @default.
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• W1573918526 date "2012-03-01" @default.
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• W1573918526 title "Need for Oversight and Standardization of HIV Screening for Living Organ Donors" @default.
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• W1573918526 doi "https://doi.org/10.1111/j.1600-6143.2011.03890.x" @default.
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