Strides Made in Screening Transplant Organs : Medicine: Even with safeguards, diseases have been introduced. Some experts call for complete autopsies, a move that would delay funerals and possibly discourage donations.
Over the past three decades, the selection and screening of organs for transplant has had an element of trial and error.
In the 1960s, organs such as kidneys were routinely harvested from dying cancer patients, resulting in malignancies in nearly half the recipients, according to Dr. Israel Penn, professor of surgery at the University of Cincinnati Medical Center, who tracks tumors in transplant recipients. As a result, cancer patients--except for those with some brain tumors--are excluded from donation.
In the 1980s, the emergence of the human immunodeficiency virus that causes AIDS resulted in other recipient deaths. After a Virginia case in which scores of blood, tissue, bone and organ recipients from a single donor were exposed to HIV that had gone undetected, a new series of donor screening tests was added and later refined.
Today, the Richmond, Va.-based United Network for Organ Sharing, which coordinates the national network of regional, nonprofit transplant organizations, requires blood and other laboratory tests designed to detect hepatitis and HIV. Recipients of the human growth hormone are also excluded because it is derived from pooled human donors and thus is considered an additional exposure factor for HIV, as well as for other undetected viral diseases, including Creutzfeldt-Jakob disease.
Organs to be harvested are then visually inspected for external signs of malignancy. In addition, the donor’s family fills out a complete medical history, including drug use and high-risk sexual activity.
For corneal transplants, which do not require anti-rejection drugs, the Eye Bank Assn. of America requires laboratory tests for syphilis, as well as hepatitis and HIV. However, according to the association and medical literature, over the past 15 years four people who received corneas from donors with undiagnosed cases of rabies have died from that disease within 30 days of the operation, including two recipients from the same donor in Thailand.
Some organ transplant programs around the country, such as Indiana Organ Programs, have added other precautions to spot undiagnosed malignancies. They require X-rays and full, open abdomen and chest examinations in order to allow visual inspections of all major organs, even those not being harvested. Any tests done in connection with the donor’s fatal illness or injury are also scrutinized.
Even with these safeguards, diseased organs have been transplanted. Documented U.S. cases, in addition to Ruth Glor:
* In 1986, four organs were removed from a 36-year-old Philadelphia woman who died of an apparently spontaneous cerebral hemorrhage. Within six months, recipients of the woman’s liver and one of her kidneys died of a form of uterine cancer, according to articles in the journals Transplantation and Views.
* Two years later, four organs were harvested from a 14-year-old North Carolina patient who doctors believed had a brain tumor, according to an upcoming article in Transplantation. Subsequent tests determined that the cause of death was metastatic melanoma, which led to the death of a 44-year-old woman who received the liver. The kidney recipients were taken off immunosuppressants, which resulted in the rejection and removal of their transplanted organs. The heart recipient died.
After the Philadelphia case, Transplantation wrote that “rapid screening methods for tumor and viruses could limit this kind of problem. Donors should have a complete autopsy after completion of organ removal.”
But, transplant experts say, requiring families of potential donors to agree to an autopsy--which would inevitably delay the funeral--is likely to reduce survivors’ willingness to allow harvesting, perhaps cutting donations in half. Further, doctors say, most harvested organs would deteriorate in the 24 to 48 hours that most autopsies take.
In a recent medical journal article, Dr. Thomas E. Starzl, whose patient died after receiving a liver in the Philadelphia transplants, acknowledged the potential dangers of unknowingly transplanting malignant organs.
Before an organ is harvested, the University of Pittsburgh pioneer said, “somebody should look at it very carefully . . . rather than just plucking the organ.”
