Donor-Derived Infection: Epidemiology and Outcomes

Abstract

Over the past decade, the solid organ transplant community has focused increased attention on unexpected transmission of infectious pathogens from organ donor to recipient. While unexpected donor-derived infections are relatively uncommon, recent cases of transmission of human immunodeficiency virus (HIV) and hepatitis C to multiple recipients, as well as transmission of HIV from a living donor, have further increased interest in improving the safety of solid organ transplantation. This article will review the epidemiology and outcomes associated with unexpected donor-derived infection. Furthermore, the reporting and patient safety process will be discussed, as will preventative measures that can reduce the burden of donor-derived infection.

HIV and the spectrum of human disease

“…Since the 1980s, the routes of HIV transmission have been delineated: Materno‐fetal–child (MTC): ∘ In utero . ∘Around the time of delivery. ∘Via breast milk. Ano‐rectal in men who have sex with men (MSM). Heterosexual in both directions (vaginal and penile infection). Injection in intravenous drug users (IVDU). Transfusion of HIV‐infected blood products. Accidental inoculation, eg to health care workers. Organ transplantation . …”

The Great Masquerade: Donor-derived Infections with Uncommon Central Nervous System Pathogens

“…The number of those waiting for life-saving organ transplantation has doubled during the last two decades, while the number of transplants has only increased by 30% [1,2]. Organs from donors with known (i.e., expected) treatable infections, or at increased risk of infections, are increasingly being utilized to offset this need [1,3].…”

“…Such events can occur when the donor has an asymptomatic, subtle, or atypical presentation of a transmissible infection at the time of death [9]. Procedural measures may fail to capture unexpected DDI when screening is not done for geographically endemic pathogens, screening is done too early (e.g., serology fails to detect early infection), or the donor has an infection that is not routinely screened for [2,3].…”

“…During the past two decades, donor-derived CNS pathogens, such as West Nile virus (WNV), Balamuthia mandrillaris, lymphocytic choriomeningitis virus (LCMV), and rabies virus, among others, have been reported in clusters of SOT recipients [11,12]. Clinically recognizing these CNS infections in potential deceased donors is enormously challenging as many are clinically silent, overshadowed by other confounding events (e.g., trauma, cerebral disease, or overdose), and donor information is often limited [3,6,10]. Overall, the lack of effective therapies, delayed recognition due to the pathogens' rarity, and the underutilization of reporting systems has resulted in devastating outcomes in SOT recipients [6,[11][12][13].…”