On Friday, April 27, I represented AST at a Northwestern/ASTS/AST sponsored consensus conference on donor-transmitted diseases, specifically HIV, HCV, and HBV. These are the infections addressed in the recent draft Public Health Service guidelines now undergoing comprehensive revision. The discussion was vibrant, and the topic important. However, between 2007-11, a five-year period during which organs from over 39,000 donors were utilized, there were 20 proven or probable transmissions from 9 deceased donors in the United States! Transmission from living donors is even rarer (a potential living donor is more likely to die intraoperatively [risk 0.0003] than to transmit one of these diseases!), with at least one of the recently publicized cases clearly due to human error.
It became obvious during the consensus conference that we were trying to develop a set of recommendations for a "high-risk" issue that in scope remains relatively small compared to dozens of other risks inherent in the transplantation process. Trying to build each element into the informed consent process is a daunting challenge just for these three viruses, not to mention all the other variables each of us knows is more important to both donor and recipient.
Our responsibility is to make sure the organ supply is as safe as possible, no question, and that all involved are adequately informed. However, I am reminded of a story that the safest way to spend one's life is in bed, alone. Not much life, though.
How do we deal with this issue and appropriately communicate with potential donors and recipients?
Robert S. Gaston