Surgeons Object to New CDC Organ-Screening Guidelines

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SEPTEMBER 22, 2011, 1:58 PM ET
Surgeons Object to New CDC Organ-Screening Guidelines

By Laura Landro

New guidelines for stricter testing of organ donors are raising concerns among transplant surgeons, who fear they may limit availability of organs.

The Centers for Disease Control and Prevention yesterday issued new guidelines recommending that all organ donors be checked for HIV and hepatitis B and C with the most sensitive screening method, known as nucleic acid testing, the Wall Street Journal reports today.

Mitchell Henry, president of the American Society of Transplant Surgeons, and chief of the transplant center at Ohio State University, tells the Health Blog the guidelines go too far in the pursuit of safety, and don’t take into consideration the realities of organ transplantation — which is often performed in life-and-death situations with little time to spare.

“We support guidelines which help to decrease disease transmission, but we want them to be evidence-based and balanced by the risks of dying without an organ transplant,” says Henry.

Guidelines were last updated in 1994, when the more sensitive tests weren’t yet in use, and covered only HIV.

Nucleic-acid testing, or NAT, can detect an infection acquired seven days before testing. Standard blood tests, known as serologic testing, measure antibodies to an infection that may take months to appear. Only about half of procurement labs in the country voluntary use the newer test, but it can double screening costs.

Moreover, Henry says NAT isn’t always feasible — for example, if an organ has to be flown to a transplant center from a remote location where no labs are available.

The proposed guidelines also broaden the types of donors considered to be at increased risk of spreading an infection. Henry says his group believes they now classify too many segments of the population as riskier donors  even though they might be good candidates, such as anyone who has had sex with two or more different partners in the last year. “That could cover three quarters of college kids in America,” Henry notes.

Matthew Kuehnert, who oversees blood and organ safety for the CDC, stresses that the guidelines are meant to give potential recipients and their doctors as much information as possible about risks of any organ, so they can make an informed decision about using it.

As to concerns the recommended guidelines may limit organ availability, he says the aim is the opposite. “The guidelines may actually expand available organs by providing more confidence in the risks assessment of the donor, which will in turn improve the chances a patient and doctor will accept the organ,” Kuehnert says.

Organs that are positive for infections other than HIV can still be transplanted, “but we just want to make sure we are aware so the recipient can be treated and we can mitigate complications of infections when they do occur,” Kuehnert says.

While the federal guidelines are not enforceable, Henry notes that they usually become mandatory standards of care. Comments can be submitted for sixty days and his group — along with several others –  plans to submit comments protesting that the CDC did not take its concerns into account and suggesting possible modifications to the guidelines.

Kuehnert responds that the CDC will take public comments seriously and revise guidelines where appropriate. “We realize change is difficult and we want to work with the transplant community to make the guidelines as useable as possible,” he says.


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