Author – Matthew J. Kuehnert, MD
Director, Office of Blood, Organ, and Other Tissue Safety
CDC Division of Healthcare Quality Promotion
More than 100,000 people in this country anxiously await an organ transplant. Some people will receive a live-saving transplant eventually; however, an average of 18 of the sickest people on the United Network for Organ Sharing (UNOS) wait list die each day waiting for an organ. There is a risk of dying from the transplant too. Given the dire need for organs, sometimes organs are used from donors that have risks for disease. So how safe do transplants need to be?
Before organs are recovered from the donor, the donor’s medical and behavioral history are reviewed. This is difficult because next of kin or friends may not know all the answers. Donors also are screened for a variety of potentially infectious diseases through laboratory tests. That said, with the exception of those testing positive for HIV, no donor is required to be excluded.
It is estimated that 1% of organs transplanted in the U.S. each year harbors a disease that comes from the donor (i.e., donor-derived disease) – either an infection or cancer. However, this number likely is an underestimate – we only know what is recognized and reported. Examples of transmitted pathogens or diseases include an array of parasites, fungi, bacteria, and viruses – from emerging and unusual infections such as Balamuthia, rabies, and lymphochoriomenigitis virus (LCMV) to the more common but equally devastating infections such as tuberculosis, West Nile virus, and hepatitis C virus.�
I lead an office at CDC that investigates reports of suspected transplant-transmitted infections. These reports are critical, because some of the transmissions may be entirely preventable. Each investigation allows us to better understand why unrecognized transmission occurs and how common it may be. While these reports are relatively small in number compared to the number of organs that are transplanted overall, there is so much that we still do not know about disease transmission through organ transplantation in the United States.
What we do know, is that few individuals who wait for an organ transplant can imagine that the organ they receive could harm or even kill them due to an unrecognized disease that comes from the organ itself. That makes it essential for healthcare providers to talk to their patients about the potential benefits and risks associated with an organ transplant.
Considering that there are not enough donated organs to meet the needs of the people who need organ transplants, how much risk do you think is acceptable for transplant patients, and what should they be told about the risks that might come from their donor?