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Ex Vivo Infection of Human Lymphoid Tissue and Female Genital Mucosa with Human Immunodeficiency Virus 1 and Histoculture

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Should deceased donors be tested for vCJD?

Ruth M Warwick¹, Roger Eglin

¹Tissue Services, Deansbrook Road, Edgware, HA8 9BD, Middlesex, UK. ruth.warwick@nbs.nhs.uk

Cell and Tissue Banking

|November 26, 2005

Summary

The precautionary principle in the UK suggests liability for defective transfusion products based on defectiveness, not negligence. Testing lymphoreticular system (LRS) tissue for variant Creutzfeldt-Jakob disease (vCJD) in deceased donors is proposed to prevent transmission.

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Area of Science:

Prion disease research
Public health policy
Transfusion medicine

Background:

UK legal precedents (BSE enquiry, Hepatitis C litigation) emphasize liability for defective products, not negligence.
Variant Creutzfeldt-Jakob disease (vCJD) infection likely occurs orally, with infectivity in the lymphoreticular system (LRS) preceding central nervous system involvement.
Epidemiological studies show a measurable carrier state for vCJD within LRS tissue.

Purpose of the Study:

To explore the potential for vCJD transmission through transplanted tissues.
To evaluate the feasibility and implications of testing deceased tissue donors for vCJD.
To inform preventative strategies against vCJD transmission in transplantation.

Main Methods:

Review of UK legal precedents and epidemiological studies on vCJD.
Analysis of animal models regarding vCJD infectivity pathways.
Consideration of potential LRS tissues for donor screening and associated practical challenges.

Main Results:

vCJD infectivity is likely present in the LRS before clinical onset, suggesting potential for transmission via tissues.
Two suspected vCJD transmissions via blood transfusion highlight the risk.
Existing vCJD assays are not validated for deceased donor screening.

Conclusions:

Testing deceased tissue donors for vCJD is a potential preventative measure against transmission.
Logistical, ethical, and social issues surrounding donor testing require careful consideration.
Further research and validation are needed for implementing vCJD screening in tissue donation.