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Investigating Rare Transplant-Transmitted Infections

Categories: Healthcare-associated infections, Organ Transplant Safety

Balamuthia mandrillaris trophozoites

Balamuthia mandrillaris trophozoites

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?

Public Comments

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this blog is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

  1. November 14, 2010 at 10:24 am ET  -   natasha cole

    you take on a lot when you are sick and have to have treatments of any kind, yet now I find that you have to look out for your self and be even more in form then before.you must be aware and stay on top of what has yet to come. yes there should be more tests done and you should be told what could happen. you can only take so much.Mandatory reporting of any illness is important in your right to get a transplant.When you give that consentual decision you give your right to choose. We should be inform and made aware of what tests are done and what could happen with transplant.

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  2. November 8, 2010 at 3:01 pm ET  -   Janet Handal

    I am a recent kidney transplant recipient who listed at multiple transplant centers. In doing research to determine where to list, I was quite surprised to learn the relatively few tests for infection that are required by the government. It is up to each organ procurement organization to decide if they want to test for additional pathogens and, if so, which ones. None of this information is typically given to the patient. When listing for transplant you are required attend a transplant education class, and while they tell you it is up to you to say yes or no to a specific transplant offer, there is no coaching about what questions one should ask to make a truly informed decision. Typically information is only given re extended criteria versus standard, and high risk versus regular risk. This information is in the hands of the transplant surgeons and the coordinators and one must to rely on their decision regarding a variet of other pieces of information, unless you know to ask specific questions. While one gives consent, it is not, in my opinion, truly informed consent.

    I believe that government mandated standards should be implemented regarding:
    1. Information to be provided when offering an organ,
    2. What infections the organ has been tested for and results,
    3. If any other pathogens are suspected and the risk if one should develop this infection,
    4. Mandatory, timely reporting of any post transplant donor or recipient infections to the OPO and a national center,
    5. Timely notification re donor or recipient infection to transplant centers which have used organs or tissue from the same donor.

    For people for whom the choice is “accept the organ” or death, I understand that there is not really a choice. But for people not in this life or death situation, such as kidney transplant patients, to risk or lose one’s life as a result of not being aware of the potential risks of accepting a particular kidney is completely unacceptable.

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  3. November 7, 2010 at 3:38 pm ET  -   Michael E. Bailey

    The issue of reducing transplant organs if an illness of unexplained type is detected in the donor is a complex one that really depends on the type of organ to be transplanted. If the organ is a critical one and the recepient patient would have no hope of recovery without it, then I think the transplant should be done but that the hospitals involved should be open with the care team and the patient about possible infection so informed choice can be made. If, on the other hand, the orgdan to be transplanted is not quite as critical like a kidney or an eye, then there might be time to wait for a known healthy donor. In every case part of the workup for removing and transplanting organs should require blood work. And it should be possible for the blood work to include screening tests for known types of infections. Health IT should make for rapid transfer of this information from donor hospital to transplant hospital so that if there was an infection detected preparations can be put in place at an early stage to combat it. It is also important to have clear written guidelines in place everyone understands and maybe that sets up a scale based on criticality of the organ involved and the need to determine an acceptable risk for possible infection. And have open communication with the transplant patient on possible infection risk. Best wishes, Michael E. Bailey.

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  4. November 5, 2010 at 6:54 pm ET  -   Stephanie

    It is very important for organs to be screened and that people are given the choice to accept or reject an organ. But even more importantly I would support the establishment of a post-transplant infection surveillance system that allows health care providers to study these disease patterns and develop better controls In The future.

    http://www.stephmf.com

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  5. November 5, 2010 at 10:35 am ET  -   Shannon Steffen - Angel Cove

    The risk of not getting a life-saving organ transplant outweighs the risk of infection from the donated organs. Being the wife of a double lung transplant recipient (with CF), the 3.5 years of waiting and the 5 dry runs was worth having my husband around for even another day.

    The hospitals told us of the risks and there was even a false positive of MRSA in his new lungs. As long as the hospital was open about such information, we remained positive that the new lungs were worth the wait. The transplant hospital made sure that he received the perfect lungs for him and he will be celebrating 6 years post-transplant next week without even the smallest amount of rejection.

    Hospitals need to perform due diligence while remaining open in their communication efforts with the patient and families. The wait is worth it for this miracle.

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  6. November 4, 2010 at 11:24 am ET  -   Michelle Millikan-Wilkin,LPN

    I don’t think we should do anything to limit organs at this point, but I do think there should be some form of mandatory reporting of illness following a transplant. Without more information to draw upon, doctors, nurses and patients are not able to make a fully consentual decision.

    What, if anything, is being done to collect the data necessary so that further research (preventative and curative) can be completed?

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