To top it all off, the most commonly used tests for viruses can fail to detect what they're supposed to pick up if the tests are performed too close to the date of infection. This problem came to light in November 2007, when four patients contracted HIV and hepatitis C simultaneously after receiving organs from the same donor. Since the infection was so recent, his immune system hadn't yet produced enough antibodies to test positive for both diseases.
But the risk factors in transplants are often outweighed by the pressing need for an organ. There are currently some 97,670 people on waiting lists for organ transplants in the United States—an all-time high—and more than 6,000 people die each year while waiting. Since so many of these patients are terminally ill, the choice becomes accepting an organ that has some chance of carrying disease or else facing certain death. "We’re always weighing risk versus benefit with organ donors," says Dr. John Brems, professor of surgery and chief of intra-abdominal transplant surgery at Loyola University Health System. "When it’s the end of the line [for patients awaiting transplants], often there’s no other treatment available."
Because the demand for organs so far exceeds the supply, UNOS does not prohibit transplantation of an organ from a donor with a history of cancer or high-risk sexual behavior. It does, however, require that hospitals obtain signed consent from a transplant recipient when the organ involved meets the criteria for high risk, and therefore might be diseased.
Organ procurement agencies and physicians must at minimum abide by UNOS guidelines, but they are free to adopt more stringent policies regarding screening donor tissues for infections, as well as examining patient and family histories to determine whether the donor engaged in dangerous behaviors or has been exposed to less obvious infections. "When a donor dies, the donor procurement agency does its [standard testing], and then the accepting hospital may ask for other tests to be done," says Dr. Brems. "It’s up to the physicians accepting the organ to decide what their own criteria are."
Brems says most surgeons have not demanded close testing of organs when the cause of death is listed as bacterial meningitis, but after the Koehne case, he expects this to change: "If it’s a diagnosis of bacterial meningitis, we should ask, 'What is the organism that [the disease] grew out of?'" If the meningitis-causing organism can't be identified in a donor's body, says Brems, it should raise red flags for any doctor who might consider using the donor's organs.
On the whole, the system keeps the vast majority of transplant recipients safe—among the more than 230,000 major-organ transplants that took place between 1994 to 2006 nationwide, only 64 recipients developed cancer as a result of their transplant, according to UNOS. Still, the safeguards are not foolproof. "We do as much testing as humanly possible, but there’s bound to be a case where a tumor or some type of viral infection gets through that we just don’t know about and can't test for," Brems says.
