How to reconcile viral safety and efficacy in organ procurement

Abstract

Several human viruses can be transmitted by solid-organ and tissue transplantation [1]. This group of pathogens includes human immunodeficiency virus type 1 (HIV-1), hepatitis B virus (HBV), hepatitis C virus (HCV), cytomegalovirus (CMV), human T-lymphotropic virus (HTLV) and rabies virus. The exclusion of donors on the basis of clinical evaluation and virological testing has markedly reduced the risk of virus transmission through transplantation [2]. However, despite the high cost of such a prevention policy, a low residual risk of virus transmission is still present. On the other hand the requirement for virological testing may contribute to the inappropriate exclusion of organ donors due to either false-positive or missing results at the moment of organ allocation. Mandatory screening is not identical among the different European countries and this is an additional obstacle for optimizing the potential use of donor organs at the level of the European Community. In this context, guidelines for preventing virus transmission should be standardized in the search for an international consensus, and should take into account the benefit of the transplant to the recipient as compared to the risk of transplant-induced disease of virus etiology.