50 Transplants May Be Tainted by AIDS Carrier

Health officials continued to search Friday for 50 or more transplant recipients who may have received organs, tissue or bone grafts from a donor whose infection with the AIDS virus had gone undetected.

While the potential danger of AIDS infection from organ transplants is not unknown, this is believed to be the largest number of patients affected by a single donor, federal health officials said.

The three patients who received the man’s kidneys and heart already have died of AIDS, while the recipient of a bone graft in Colorado has tested positive for the potentially fatal virus, according to Food and Drug Administration officials. A fifth patient, who received the donor’s liver, died from post-surgical complications, they said. The location of the donor’s pancreas is still unknown, officials said.

Investigators are now trying to contact the other recipients through the 30 hospitals across the country where the organs and tissues were distributed. The FDA said that almost all of the institutions have been notified. Neither the hospitals nor the recipients were identified. The search was first reported by the Atlanta Journal-Constitution.

Virtually all organizations involved in transplantation now routinely test the blood of organ donors for AIDS infection before organs are used. Officials said that there is no evidence at this time to suggest that proper procedures were not followed in this case.

The donor, a 22-year-old Virginia man who died in October, 1985, of a gunshot wound to the head, had tested negative twice before his organs were removed, officials said. His organs were distributed by LifeNet Transplant Services, a tissue bank in Virginia Beach, Va..

Officials have speculated that the AIDS test, which was far less sophisticated at that time than it is now, simply failed to detect his infection. Also, they said, he may have been infected so near the time of his death that his immune system had not yet manufactured antibodies that would have been picked up by the screening.

This so-called “window” of time, which can run six months or longer, continues to create a similar, although smaller, risk in the nation’s blood supply. The risk of receiving AIDS-contaminated blood ranges from 1 in 40,000 to 1 in 153,000, depending on the prevalence of AIDS in the geographic area.

However, unlike blood donors--who are asked about AIDS risk factors before they are allowed to donate--organ donors are not afforded the same opportunity.

“Family members are the ones who have to provide consent and they often don’t know,” said Dr. Robert T. Schooley, an AIDS specialist who heads the infectious diseases unit at the University of Colorado Health Sciences Center.

LifeNet officials said Friday that improved tests performed on preserved cells from the donor had indicated that he was infected.

“It’s tragic,” said Doug Wilson, a LifeNet official, speaking at a press conference in Virginia Beach. “It’s unfortunate. Certainly we were not negligent. The science was simply not there. The likelihood of this happening today is slim to zero.”

Federal officials said that there is probably no way the system can be made any safer than it is now.

“It’s just a risk we have to take right now because there is no testing that will catch these rare cases,” said one Public Health Service official. “The risk--as shown by this isolated case--continues to be minimal.”

In addition to the five fresh organs--the heart, kidneys, liver and pancreas--there were 52 tissue or bone grafts believed to have been implanted, the FDA said, including the Colorado case. Thirty-nine of the grafts were freeze-dried and treated with ethanol, and six were freeze-dried and treated with radiation. These procedures are routinely used to kill bacteria before transplantation but it is unclear whether they are effective in killing the AIDS virus.

“We can’t say with 100% certainty that it kills the virus but it’s likely to reduce the risk,” said Jeff Nesbit, a spokesman for the FDA.

But Schooley said that at least one study, conducted three years ago at Massachusetts General Hospital, showed that the amount of radiation necessary to kill the virus “was way in excess of what was usually used to kill the bacteria.” Large amounts of radiation typically would not be used because they would damage the graft, he said.

The remainder of the grafts, including the one used in the Colorado transplant, were frozen, which has no effect on the AIDS virus.

The FDA said that the patient’s corneas were harvested, as were several vials of bone marrow. “The bone marrow had been distributed to the Navy and all of it has been recovered,” Nesbit said. “None of it was used in humans.”

The fate of the corneas is unknown, although the eye bank that received them has been notified, the FDA said.

The risk of AIDS has always loomed over organ transplants, since young adults make up the majority of AIDS cases and young adults killed in accidents or in other violent deaths are the major source of organs.

Thus far, however, there has only been a handful of such cases. The first known case occurred in 1982, before a test was available to detect the AIDS infection. An infected man donated a kidney to his sister, who later developed AIDS and died.

Alissa Freitag, an official with the nonprofit United Network for Organ Sharing--which operates a procurement and transplantation network for the federal government--said that it is unusual for so many people to have been affected.

“Nevertheless, there are so many different ways that one donor can help people, it certainly can happen,” she said.