Organ transplants and skin grafts

HIV infection has occurred as a consequence of transplants of the liver, kidneys, pancreas, bone marrow and the heart, and also as a consequence of skin grafts. The most dramatic case occurred following the death of a donor who had tested HIV-negative at the time organ use was approved. Subsequently the donor seems to have seroconverted, because recipients of the heart, kidneys, liver and bone seroconverted after transplantation. Recipients of other processed bone and avascular soft tissue (tissue without blood supply), ligaments, corneas and the dura mater (the membrane which protects the brain and the spinal cord) did not become infected, indicating that it is vascular (blood bearing) organs which constitute the greatest risk.¹

A more recent case occurred in Chicago in 2007. Following a man’s death in a car accident, his family gave consent for his heart, liver and two kidneys to be donated to others. Blood tests for HIV and hepatitis C antibodies were both negative.

However all four recipients of the organs later seroconverted to HIV and hepatitis C, with viral strains that were closely matched to those of the donor. Subsequent nucleic acid testing (i.e. to measure viral load) of stored blood samples from the donor revealed that he had had HIV and hepatitis C at the time, but was probably in the window period recently after infection.²

In 2009, HIV was transmitted during a kidney transplant in New York. The Centers for Disease Prevention and Control (CDC) says this was the first confirmed case of transmission from a living organ donor since 1989. The donor had tested negative on an antibody test, but there was a delay of ten weeks between the day of donor assessment (including the HIV test) and the day he actually donated his kidney. Moreover, he subsequently told doctors that he had had unprotected sex between those dates. Phylogenetic analysis showed that the viruses of donor and recipient were highly related.³

Grafted skin was also the source of HIV infection in an individual who had been treated for severe burns.⁴

All donors of organs, tissues, eggs and semen are tested for HIV, but this does not completely rule out the possibility of infection, because of the 'window period' before antibodies form. It is still common for organ donors to only be screened with an antibody test.

In September 2011, the CDC issued draft guidelines stating that nucleic acid testing (HIV RNA tests) should also be used, as it has a shorter window period. Moreover, when there is a living donor, HIV testing should be repeated no more than seven days before the time of organ donation.