“Life is either a daring adventure or nothing at all.” – Helen Keller
Infections from Donated Organs, What You Need To Know
Organ transplantation is a life-saving procedure. However, one significant risk associated with this procedure is the potential transmission of infections from donated organs. The quote above by Helen Keller is particularly poignant when considering the high-stakes associated with organ transplantation. Risk-taking is a necessity in achieving significant breakthroughs and advancements in medical science. This resonates with many transplant recipient’s experiences, challenges and hopes associated with the organ transplant journey.
As global organ transplantation practices evolve, understanding and mitigating these risks have become crucial. This post delves into the prevalence, causes, and preventive measures related to infections contracted from donated organs which are then transferred to the recipient. In writing this post I have drawn on research from Australia, the United States, New Zealand, and the United Kingdom.
Prevalence of Infections from Donated Organs
Australia
In Australia, the risk of infection from donated organs is a critical concern for the medical community. According to the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA), infection-related complications are a leading cause of morbidity and mortality among transplant recipients (ANZDATA, 2023).
United States
The United States also faces significant challenges in this area. A study published in the American Journal of Transplantation highlighted that bacterial, viral, and fungal infections are prevalent among transplant recipients. Approximately 15% of patients developing severe infections within the first year post-transplant (Kumar et al., 2023).
New Zealand
In New Zealand, the New Zealand Blood and Organ Service (NZBOS) reports that the incidence of infections in organ recipients is relatively low. Vigilance and rigorous screening processes are necessary to maintain this status (NZBOS, 2022).
United Kingdom
The UK’s National Health Service (NHS) also emphasises the importance of screening and monitoring. The NHS Blood and Transplant (NHSBT) data indicates that about 10% of transplant recipients have infections. This situation requires continuous improvement in screening protocols (NHSBT, 2023).
Why Are There Risks Of Infection From Donor Organs?
Essentially donor organs are screened for infection risk. However, the screening process is not 100% accurate. Partly due to the restricted life-span of retrieved organs. Doctors work quickly to assess an organ. They must retrieve, transfer and transplant it before it is no longer viable. Thorough testing and risk assessment of potential donors are completed to optimise the transplant outcome.
High-risk behaviours of potential donors are considered as these may indicate a higher risk for HIV and Hepatitis infections. This is why the transplant work up includes screening and vaccinations for Hepatitis B.
During the work up, you will be required to consent to specifically accept an organ. This organ may have an increased risk of Hepatitis B, Hepatitis C, or HIV. However, you are not forced to accept. If you look at the consent form I signed, you can see the options available. These options include organs with extended criteria and higher infection risk.
Not performing the heart transplant was a greater risk for me as I was palliative. It is important to know that with medical advancements, Hepatitis and HIV are treatable and curable. Importantly, my end of life heart failure and sustained VT storms were not. Death was the only outcome possible for me. Therefore, I was willing to accept an organ with extended criteria and higher infection risk.
The Screening Of Donor Organs
The Screening Of Donor Organs includes multiple blood tests. When pathology results suggest potential donors are a high risk the team investigates the time frame of exposure. Examples of a potential risk include intravenous drug use, unprotected sex and incarceration. Exposure and blood results determine whether or not organ retrieval will proceed.
It is important to know that not all illnesses and infections can be tested prior to retrieval and transplantation. Due to the time sensitivity, not all investigations can be carried out. This means we may not discover all there is to know about a potential donor.
Unfortunately there is also potential for pathology results to be false positive and/ or false negative. For example as part of the work up transplant patients are screened for Tuberculosis and Hepatitis.
During this process I was screened for Tuberculosis and Hepatitis. The pathology results showed I was positive for both. The positive result was incorrect. I had just completed the Tuberculosis test. A recent booster for the Hep B vaccination created a false positive. The tests needed to be repeated after 7 days where pathology results showed I was negative.
Causes of Infections from Donated Organs
Infections can be transmitted through donated organs due to several factors. These factors include the donor’s health status and undiagnosed infections at the time of donation. Additionally, the immunosuppressed state of recipients plays a role.
Common pathogens include bacteria such as Escherichia coli, viruses like cytomegalovirus (CMV), and fungi such as Candida species. Organ Infections: An Overview
Bacterial Infections
Bacterial infections are often caused by pathogens present in the donor’s bloodstream or the organ itself. Infections can arise during organ retrieval, storage, transfer and transplantation procedures.
Viral Infections
Viruses such as CMV and Epstein-Barr virus (EBV) are common among transplant recipients. These viruses can be dormant in donors and become active in recipients due to immunosuppression.
Fungal Infections
Fungal infections, particularly those caused by Candida and Aspergillus species, pose significant risks. These infections can lead to severe complications, especially in lung and liver transplant recipients.
For more detailed information about common infections read my post: Infections After An Organ Transplant.
Preventive Measures
Enhanced Screening Protocols
Countries like Australia and the United States have implemented advanced screening protocols to detect potential infections in donors. These protocols include nucleic acid testing (NAT) for viruses, bacterial cultures, and serological testing for a wide range of pathogens.
Prophylactic Treatments
Administering prophylactic antimicrobial treatments to recipients is another strategy to prevent infections. This approach is particularly effective against bacterial and viral infections.
Post-Transplant Monitoring
Continuous monitoring of transplant recipients is vital. Regular blood tests, imaging studies, and clinical assessments help in early detection and management of infections.
Read the post: Crucial Testing After A Heart Or Lung Transplant for more details on post transplant health screening.
International Collaboration
Global collaboration among transplant organisations can enhance the sharing of data and best practices, leading to improved outcomes worldwide. Initiatives such as the Transplant Infectious Disease (TID) group facilitate knowledge exchange and standardisation of protocols internationally.
Conclusion
Infections from donated organs remain a significant challenge in transplantation medicine. However, through enhanced screening, prophylactic treatments, and rigorous post-transplant monitoring, the risks can be minimised. International cooperation and continuous research are essential to advancing safe transplantation practices. As the global community strives for better outcomes, staying informed and vigilant remains key.
See the post on Practical Tips For Preventing Infections After A Transplant or read about Getting Your Transplant Call. If you are still doing your work up for transplant you could read the post: Heart Transplant Eligibility Requirements. Related posts include: Living Organ Donations, Infections After An Organ Transplant and Types of Organ Donation.
Please share your story or comments in the form below.
W
Wednesday
References
ANZDATA. (2023). Australian and New Zealand Dialysis and Transplant Registry Annual Report. Retrieved from anzdata.org.au
Beliaevski, R. (n.d.). President’s message. Retrieved July 1, 2024, from https://tts.org/tid-about/tid-presidents-message
Kumar, V., et al. (2023). “Infection Risks in Organ Transplantation: A Comprehensive Review.” American Journal of Transplantation, 23(4), 789-805.
NZBOS. (2022). New Zealand Blood and Organ Service Annual Report. Retrieved from nzblood.co.nz
NHSBT. (2023). “Infection Control in Organ Transplantation.” NHS Blood and Transplant. Retrieved from nhsbt.nhs.uk
View, L. (n.d.). Living with immunosuppression after an organ transplant. WebMD. Retrieved June 13, 2024, from https://www.webmd.com/a-to-z-guides/organ-transplants-antirejection-medicines-topic-overview
