Hepatitis C Virus Transmission to Organ and Tissue Recipients FREE

Transplantation of organs and tissues from healthy donors or cadavers (dead bodies) to people whose bodies have been damaged by disease, injury, or wear and tear has become a common part of medical practice. Organs such as kidneys, hearts, livers, and lungs, as well as tissues such as corneas, tendons, skin, and bones, are routinely transplanted. One cadaver can be the source of several donated organs and as many as 100 tissues (which can be stored for many months or years). Unfortunately, in addition to the potentially healing effects of transplantation, many serious disease agents can be transmitted from the donor to the recipient, such as hepatitis C virus (HCV), which is a leading and potentially fatal cause of chronic liver disease. An organ donor with HCV infection has a great risk for transmitting the virus to a recipient. On the other hand, HCV transmission has rarely been reported in patients who have received tissue transplants, and no transmissions have been reported when the donor has tested negative for infection by using up-to-date antibody assays. An even more sensitive method of detecting HCV infection in the donor consists of testing for the presence of components of the virus itself (HCV RNA), but this test is time-consuming and expensive and is not currently required by the U.S. Food and Drug Administration.

To find out whether the donor was the source of infection when a tissue transplant recipient developed HCV infection 6 weeks after transplantation. This was particularly important because the donor had been the source of 91 donated organs and tissues.

The donor and all 40 individuals who had received organs or tissues.

Investigators tested stored blood serum from the donor for HCV RNA. Serum from the recipients (taken both before and after transplantation) was subjected to both antibody and HCV RNA tests.

Results of HCV antibody tests on blood taken from the donor before death had been negative for HCV infection, but the HCV RNA test result on stored blood was positive. Four recipients were found to have been infected with HCV before transplantation, and 1 recipient was infected with a strain of the virus that was different from the donor's (indicating that transplantation had not caused the infection). All 3 organ recipients and 5 of the tissue recipients were infected with HCV from the donor. No infections occurred in recipients of cornea, skin, or bone that had been sterilized with radiation. The remainder of the tissue that had not already been used was discarded.

Serum samples were unavailable from 5 recipients after transplantation.

More stringent testing of donors may improve the safety of transplantation procedures.