Viral Transmission in Organ Transplantation: The Importance of Risk Assessment

Abstract

Organ transplantation presents a low but extant risk of allograft transmission of bloodborne viruses (BBV) including human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). Other infections temporarily present in blood are also transmissible from donor to recipient, such as cytomegalovirus (CMV), polyomavirus (BK), Epstein-Barr virus (EBV), and others, where the donor has acute infection at the time of donation. Decisions about accepting organs for transplantation involve a trade-off between the acquisition of good-quality organs, which can confer longer survival time for the recipient, but at the risk of dying from waiting too long from the underlying condition, versus accepting an organ of less quality, but at the risk of potentially acquiring a donor-derived infection (DDI), unless such infection can be ruled out in the donated organ. In this chapter, we describe the different factors contributing to the overall risk of acquiring a BBV infection through the allograft, mechanisms for assessing risk of the donor and the different strategies available to minimize or mitigate the risk. The process is one of risk assessments and risk ameliorations through optimum laboratory and clinical assessment processes, so that transplantation professionals can balance the overall risk against the life-saving and life-enhancing benefits of organ transplantation.

Infectious Disease Transmission in Solid Organ Transplantation: Donor Evaluation, Recipient Risk, and Outcomes of Transmission

“…Using this new machine in conjunction with repeat/parallel testing protocols should effectively reduce the false-positive rate to negligible levels, and should permit prospective NAT for all organ donors. 77,78…”