An organ recipient recently contracted the virus that causes AIDS from a live kidney donor in an unidentified city hospital, the New York State Department of Health said Tuesday.
It's the nation's first documented case of HIV transmission via a transplant from a living donor since a sensitive test for the virus was approved and implemented for donor screening in 1985, a health department spokeswoman said.
The hospital followed acceptable protocols in an initial screening of the donor, the spokeswoman said, but the donor apparently had unsafe sex after the test and prior to donating the organ.
"Of course this is a rare case, but we felt like we needed to alert centers to this possibility so they can talk to potential donors about risks and do testing closer to the time of surgery," she added.
The state declined to name the hospital in the interest of protecting the privacy of the patient.
The department is now recommending that hospitals test donors for HIV and the hepatitis C and B viruses within 14 days before the organ donation, using nucleic acid testing.
NAT can detect viral infections weeks to months before antibodies are detectable by standard blood tests. It hasn't been recommended for testing organs from deceased donors because of the pressure to transplant the organs before they deteriorate, but that time crunch shouldn't apply to potential living donors, the state notes in its advisory.
Testing for infectious disease has all but eliminated the transmission of HIV through organ, tissue and blood donation. The Centers for Disease Control and Prevention last issued organ donation screening recommendations specific to HIV in 1994 and is expected to update its recommendation this year.
The state is advising hospitals to question living organ donors about risky behavior, including the use of non-medical injectable drugs. Compliance with the specific recommendation is voluntary but the department is urging all centers to update their policies for screening living donors as necessary.
The transplant community's most recent testing recommendations, which appeared in the American Journal of Transplantation last year, said that average-risk donors don't require NAT screening; they didn't address the timing of screening. The health department says it doesn't believe those recommendations are sufficiently protective because of the challenges of detecting behavioral risks and learning about the infection status of a donor's sexual partners.