Nephron Power

Sunday, July 31, 2011

In the News: CDC recommendations for Prevention and Screening of HIV infection in potential Organ Donors

The most recent CDC recs for the prevention and screening of HIV infection in potential living donors are as follows:

1. Initial screening should be done in all donors.

2. All donors should have repeat testing with a combination of HIV serologic test and HIV NAT as close to organ donation as feasible but no longer than 7 days preceding organ donation.

3. All donors have to be advised on behaviors that could be putting them at risk for HIV infection.

4. For living donors with high risk: specific counseling might be needed one on one basis.

5. Available testing cannot completely eliminate the risk of transmission and all have to be aware.

Ref:

http://www.ncbi.nlm.nih.gov/pubmed/21645260

http://www.ncbi.nlm.nih.gov/pubmed/21412210

Thursday, July 28, 2011

Live from the consensus conference on "Optimal Testing of Live Donors to Prevent Transmission of Infectious Diseases"

How do we tell a recipient that they are at high risk for a transmissible infectious disease when they are accepting a CDC high Risk Kidney?

Evaluating donors can lead to many ethical decisions. As Dr.Blumberg stated today, there is no real evidence as to what to do with high risk donors. We all agree that recipients should be aware of the increased risk if they are receiving a CDC high risk kidney. But how do we tell them? We can not tell a recipient specifics because we must adhere to hipaa regulations. We are obligated to let the recipient know of their increased risk. They can receive general information that their donor may be at higher risk....
Another important thing we can do is remind donors of their high risk behavior. Remind them of their need to avoid this high risk behavior and also that the recipient can be harmed if they continue the high risk behavior. Perhaps another meeting after the initial visit should be initiated to talk to them about their high risk. If they can not make behavioral modifications they should be given the choice to opt out of the donation process as risk may be greater than the benefit.

Live from the consensus conference on "Optimal Testing of Live Donors to Prevent Transmission of Infectious Diseases"

What is the optimal testing strategy for testing live donors?

In a lecture given by Dr. Michael Ison, we can see that this is an area of great debate. We all agree that potential donors should have serology done for hepatitis b, hepatitis c, and HIV on initial visit. But should we repeat testing? Should we do repeat testing for everyone or should we repeat testing for high risk donors only? And what would this repeat testing mean? When is the optimal time to repeat this testing?
A suggestion was that possibly we can do repeat hepatitis B core and surface antigen testing, and nucleic acid testing for hcv and HIV. 7-14 weeks prior to surgery may be a good time to do these repeat testing.

Again, these tests can result in false positives, more costs, more patient anxiety, more visits and time spent to get blood drawn which can be looked at negatively.
More experience and studies are needed to tell us what exactly should be done. For now we need to follow our instincts and do what is best for the donor and recipient.

Live from the consensus conference on "Optimal Testing of Live Donors to Prevent Transmission of Infectious Diseases

From Dr. Segev's well put lecture:
Perhaps we can stratify Kidney transplant donors into "higher risk" groups. This group can include men who have had sexual relations with other men, hemophiliacs, those who were involved in sex trafficking or received money for it, person who had sexual relations with those high risk for HIV, those who have been incarcerated, and those who use or have used iv or im drugs.
Probably at high risk would be those who use intranasal cocaine or heroin, those with recent STD, those with recent genital herpes, those who traveled to endemic areas where HIV and hepatitis c are prevalent in high numbers, and perhaps natives from endemic areas.

Once we stratify these donors, what further testing should we do? And more importantly how do we inform the recipient that their donor is high risk? Some things to ponder on!