Transplant patients should know risks: doctors

By Julie Steenhuysen

CHICAGO (Reuters) - New guidelines are needed to inform people about the risks of organ transplants after four organ recipients in Chicago got HIV and hepatitis C from a single donor last year, U.S. doctors said on Wednesday.

While tests initially showed the organs to be free from infection, the donor was known to have had a high risk of infection with the human immunodeficiency virus, which causes AIDS.

The cases were the first incidence of HIV infection from organ donation in 15 years and have stirred debate about how to best inform people of the risks of transplants.

"This is an issue that goes far beyond those people's unfortunate circumstances," said Dr. Scott Halpern of the University of Pennsylvania School of Medicine, who makes the case for new guidelines in the New England Journal of Medicine.

"It is applicable to all patients seeking organ transplants regarding what they have a right to know and when they have a right to know it," Halpern said in a telephone interview.

Halpern said current guidelines do not adequately protect patients' rights to make fully informed decisions.

He and colleagues propose the United Network for Organ Sharing or UNOS, which sets U.S. policy for organ donation, create guidelines to disclose "all foreseeable risks" of transplant surgery when a person is placed on the organ transplant list.

This would give patients the right to opt out of receiving higher-risk organs, including organs from people who are at risk for infectious diseases.

Halpern said currently, if an organ becomes available and a surgeon is aware that it came from a high-risk donor, he or she would disclose that at the time of the transplant.

"That creates a whole host of problems, including inequity and the potential for discrimination," he said. And it wastes precious time, reducing the chances that someone else might be able to use that organ, he said.

CHOOSING UP FRONT

Instead, Halpern thinks people should be told of the risks up front and indicate whether they would accept a riskier organ or only one that is from a lower-risk donor.

Halpern and colleagues said this would reduce the opportunity for people to "cherry pick" the best organs, or to only decline an organ from someone who was at high risk for HIV -- a group that includes homosexual men, people who have been in prison and injectable drug abusers.

Halpern said telling patients about HIV risk, without disclosing risks about other diseases like high blood pressure, might feed into social biases.

"Because organs are so scarce and there is such a demand and the people who are getting them are in such need, the emphasis has been on increasing the number of donors and improving access to the organs and making sure there is fair distribution," Dr. Matthew Kuehnert, who oversees organ safety at the U.S. Centers for Disease Control and Prevention, said in a telephone interview.