Risk Assessment

Ideally, doctors would talk to potential recipients about the percentage of donors who may be high risk very early in the process. "You certainly don't want to bring up this issue for the first time when you basically have an organ out in front of your eyes," says Dr. Michael Millis, director of transplantation at the University of Chicago Medical Center. "We inform them early on and then what is specifically discussed at the time of transplant is between the patient and the surgeon and the coordinator."

Some transplant recipients say they can understand why an infected patient would say yes even if they knew the organ was coming from a high-risk donor. "I would be surprised if anyone who had a terminal illness, guaranteed, would turn away an opportunity to live another few years," says Earl Rosenbaum, 59, a nursing-home consultant who, until he got a liver transplant three months ago, suffered from a rare cancer of the bile duct. "Your whole life is in front of you, and you know you're not going to be here in a year or six months. You see things differently." (Rosenbaum was lucky to get a partial liver transplant from his son-in-law.) Harvey Saver, 56, of Evanston, Ill., who got a pancreas and kidney transplant five years ago, isn't sure whether he would have said yes or no if he had been told his donor was high risk. Maybe, he says, "I would have been so anxious I would have jumped at it."

As rare as the Chicago cases are, the incident has renewed the push for improved HIV testing. "The physicians and surgeons are heartbroken about [the HIV transmission], the patients are devastated," says Joel Newman of the United Network for Organ Sharing. "We have to look for something good to come out of this"—that is, better screening. Still, no test could ever detect HIV the [same] afternoon someone contracts it." Transplant specialists would like to see a test that narrows the window of HIV detection become mandatory for every donor. Until now, a required screening test, called ELISA, has been used to identify HIV-infected donors in most cases. But the ELISA test screens for antibodies which may not appear until 22 days after someone is infected with HIV.

Nucleic acid testing, which detects genetic material from the virus itself (rather than antibodies), shortens the window to about 12 days. But most hospitals don't use it. The reason: many cities, like Chicago, lack a regional testing center—so it can take more than 24 hours to get the test results. That's just too long for a donor's organs to be kept viable. A heart can last only four to six hours from the time the ventilator is turned off to the time it's transplanted into a person. "You don't have the luxury of time. You have to turn it around quickly," says the CDC's Kuehnert.

There is a regional testing center in Los Angeles that turns around the nucleic acid test in four to six hours for California, New Mexico, Nevada and Utah. But there are "logistical and organizational hurdles" to setting up more labs like it around the country, says Tom Mone, president of the Association of Organ Procurement Organizations. "Organ donation is a rare thing and testing for it is such a small market."

For now, government officials haven't said whether they will amend their recommendations on testing or patient consent in the wake of the Chicago HIV transmissions. "We're always looking to change our guidelines. It's a pretty fast-moving field," says HRSA's Burdick. "This is an extremely uncommon event, but we want to do our best to prevent it from ever happening [again]."