Routine screening of blood samples would reduce the risk of disease transmission among transplant recipients

Results of a study in this week’s issue of THE LANCET suggest that routine screening of blood samples to detect viral RNA among organ and tissue donors who do not have obvious signs of clinical disease would reduce the risk of disease transmission among transplant recipients.

The presence of blood antibodies to viral diseases such as HIV and hepatitis C is the conventional method for assessing whether an individual is safe to be a tissue or organ donor. However this approach is limited; some donors may be infected with a virus but have not yet ‘seroconverted’ (shown a full immune response to infection by producing antibodies), thereby posing a risk to transplant recipients.

Jean-Michel Pawlotsky (Hospital Henri Mondor, Paris, France) and colleagues determined whether nucleic acid testing (NAT) could detect HIV RNA or hepatitis C virus (HCV) RNA in a large series of seronegative organ and tissue donors, and whether this technique should be routinely used to improve viral safety of grafts. They studied 2236 organ donors, 636 tissue donors, and 177 cornea donors. The investigators identified five HCV RNA-positive donors in 2119 HCV-seronegative organ donors, and one HCV RNA-positive donor in 631 HCV-seronegative tissue donors. No HIV-seronegative, HIV RNA-positive donor was identified.

Dr Pawlotsky comments: “our data, together with the reported cases of HCV transmission to recipients from a seronegative HCV RNA-positive donor, suggest that routine NAT screening of organ and tissue donors might increase viral safety in the transplantation setting. Implementation of systematic NAT screening of tissue (and cell) donors is highly feasible because viral testing can be done every day and can be based on standardised, partly automated, commercial techniques and procedures...Technical flaws currently hinder routine NAT screening of organ donors, but not of tissue and cell donors. Thus NAT techniques should be rapidly adapted to organ donor screening, and implementation should be discussed.”