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#56
ESTIMATED PROBABILITY OF A COLORADO DECEASED ORGAN DONOR WITH AN EARLY UNDETECTABLE HIV, HCV, HBV OR WNV INFECTION.
Steven S. Geier, PhD. Denver CO, USA, Laboratories At Bonfils, 80230, Transplant Laboratory.
Current UNOS testing requirements for HIV and HCV rely on EIAs (Enzyme Immuno Assays) which look for antibodies to viruses as indicators of infection. EIA tests must wait for an infected individual’s immune system to recognize the infection and produce enough antibodies to be detected. The number of days a recently infected donor would not be detectable is about 22 HIV, 82 HCV, 59 HBV & 21 WNV! Nucleic Acid Tests (NAT), which directly detect viruses can detect infections much earlier: about 10 HIV & HCV, 39 HBV & 1 WNV! I estimated probability of a Colorado deceased organ donor with an early undetectable HIV, HCV, HBV or WNV infection by EIA antibody vs. NAT testing. The calculations were made multiplying the probability that a 16-60 year old would be an organ donor 1/44,334 X the probability of an early viral infection in that group X 2.3 for risky activity in some donors. The early window infections = number of new viral cases/day X number of days before EIA or NAT can detect the infection. The probability of a deceased organ donor harboring an undetectable viral infection is very low, even with just EIA antibody testing. Adding NAT testing significantly reduces the probability and creates an additional margin of safety especially for HCV & WNV. The probability of missing an infected organ donor with EIA vs. NAT & EIA for: HIV (1/4 vs.1/10) x109, HCV (1/41 vs.1/333) x106, HBV (1/504 vs.1/606) x106 & WNV (1/4 vs.1/192) x106. So why bother adding NAT viral testing? Because it will reduce the probability of a transplant patient getting a tragic infection! Ask the eight 2002 organ and tissue recipients that were infected with HCV from a donor that had a recent infection which NAT testing would have detected and prevented!