Author – Matthew J. Kuehnert, MD
Director, Office of Blood, Organ, and Other Tissue Safety
CDC Division of Healthcare Quality Promotion
In our last blog, we discussed the balance between organ availability and safety. Today, we describe recent CDC investigations of transplant-transmitted infections and their implications for this area of healthcare. Because the U.S. does not have a system to monitor disease transmission from organ transplantation, we must learn from those few cases that are recognized.
Some of the most difficult investigations involve multiple transplant patients from the same donor becoming ill from an unknown cause. This was the case in two recent clusters of transplant-transmitted Balamuthia ameba infection. In the first investigation, there were four transplant recipients; two recipients became very ill (one died), while two others remain asymptomatic. The second cluster of cases is a similar tragedy, with two recipient deaths. In both investigations, the donor had undiagnosed encephalitis (i.e., brain infection).
One of the main messages here is that transplant physicians/surgeons, organ recovery teams, and other healthcare professionals should be aware of unusual infections like Balamuthia, especially in donors with encephalitis of uncertain cause. Another point is that if a patient with encephalitis of unknown cause is considered as an organ donor, organ procurement organizations (OPOs) should communicate this elevated infection risk to transplant centers, so that patients can make informed decisions.
Although most people agree that the benefits from transplanted organs outweigh the potential risk from unintentional disease transmission, risk-benefit comparison studies need to be done so that healthcare providers can help their patients make the best informed decisions possible. It gets complicated, since not all patients on the wait list are in equal need. For example, a kidney patient medically stable while living on dialysis may not be as accepting of elevated risk as a heart failure patient without any hope for survival.
CDC continues to work with the transplant community to recognize these clusters of transplant-transmitted disease, and to minimize the risk of transmission of potentially fatal infections, like Balamuthia.
How does the need to quickly recover and transplant an organ weigh against double checking donor risk factors?
If it meant limiting the supply of organs, should public health provide guidelines for suitable organs? Do you think there should be a standard approach to patient informed consent?