Matthew J. Kuehnert, MD

Author: Matthew J. Kuehnert, MD,
Director, Office of Blood, Organ, and Other Tissue Safety

Over the past few years, my team at the CDC looked into more than 200 reports of unexpected disease transmission through organ transplantation. Of the cases that were confirmed, some had fatal outcomes. Clearly, transmission of infections through organ transplants remains a patient safety concern that calls for action.

To help address the problem, CDC recently led a team of experts to develop the Draft 2011 Public Health Service (PHS) Guideline for Reducing Transmission of HIV, HBV, and HCV through Solid Organ Transplantation. The guideline was posted to the Federal Register today, and I encourage your review and comment.

Balamuthia mandrillaris trophozoites

Author – Matthew J. Kuehnert, MD
Director, Office of Blood, Organ, and Other Tissue Safety
CDC Division of Healthcare Quality Promotion 

In our last blog, we discussed the balance between organ availability and safety. Today, we describe recent CDC investigations of transplant-transmitted infections and their implications for this area of healthcare. Because the U.S. does not have a system to monitor disease transmission from organ transplantation, we must learn from those few cases that are recognized. 

Some of the most difficult investigations involve multiple transplant patients from the same donor becoming ill from an unknown cause. This was the case in two recent clusters of transplant-transmitted Balamuthia ameba infection. In the first investigation, there were four transplant recipients; two recipients became very ill (one died), while two others remain asymptomatic. The second cluster of cases is a similar tragedy, with two recipient deaths. In both investigations, the donor had undiagnosed encephalitis (i.e., brain infection). 

Matthew J. Kuehnert, MD

Author – Matthew J. Kuehnert, MD
Director, Office of Blood, Organ, and Other Tissue Safety
CDC Division of Healthcare Quality Promotion 

More than 100,000 people in this country anxiously await an organ transplant.  Some people will receive a live-saving transplant eventually; however, an average of 18 of the sickest people on the United Network for Organ Sharing (UNOS) wait list die each day waiting for an organ.  There is a risk of dying from the transplant too.  Given the dire need for organs, sometimes organs are used from donors that have risks for disease.  So how safe do transplants need to be? 

Before organs are recovered from the donor, the donor’s medical and behavioral history are reviewed.  This is difficult because next of kin or friends may not know all the answers.  Donors also are screened for a variety of potentially infectious diseases through laboratory tests. That said, with the exception of those testing positive for HIV, no donor is required to be excluded. 

It is estimated that 1% of organs transplanted in the U.S. each year harbors a disease that comes from the donor (i.e., donor-derived disease) – either an infection or cancer.  However, this number likely is an underestimate – we only know what is recognized and reported.  Examples of transmitted pathogens or diseases include an array of parasites, fungi, bacteria, and viruses – from emerging and unusual infections such as Balamuthia, rabies, and lymphochoriomenigitis virus (LCMV)  to the more common but equally devastating infections such as tuberculosis, West Nile virus, and hepatitis C virus.�