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Donor-derived infection--the challenge for transplant safety
Jay A Fishman1, Paolo A Grossi2
1Transplant Infectious Disease Program, Infectious Disease Division and MGH Transplantation Center, 55 Fruit Street, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114-2696, USA.
Abstract:
Organ transplantation, including of the heart, lung, kidney, liver, pancreas, and small bowel, is considered the therapy of choice for end-stage organ failure. Each year, over 70,000 organs are implanted worldwide. One donor may provide multiple organs, as well as corneas and other tissues, for multiple recipients. The degree of risk for transmission of infection carried with grafts, notably of viruses, is largely unknown and, for a specific organ, difficult to assess. The approach to microbiological screening of organ donors varies with national and regional regulations and with the availability and performance of microbiological assays used for potential donors. Transmission of both expected or common, and unexpected infections has been observed in organ transplants, generally recognized after development of clusters of infections among recipients of organs from a common donor. Other than for unusual or catastrophic events, few data exist that define the incidence and manifestations of donor-derived infections or the ideal assays to use in screening to prevent such transmissions. Absolute prevention of the transmission of donor-derived infections in organ transplantation is not possible. However, improvements in screening technologies will enhance the safety of transplantation in the future.
Insights
Organ transplantation saves lives but carries infection risks from donors. Enhancing donor screening technologies is crucial for improving transplant safety and preventing infections in recipients.
Area of Science:
- Transplantation immunology
- Infectious disease transmission
- Microbiology
Background:
- Organ transplantation is the primary treatment for end-stage organ failure, with over 70,000 transplants performed globally each year.
- A single donor can provide multiple organs and tissues, increasing the potential for infection transmission.
- The risk of transmitting infections, particularly viruses, via transplanted organs is not well understood and difficult to assess for individual organs.
Purpose of the Study:
- To review the challenges and current state of microbiological screening in organ donation.
- To highlight the observed transmission of infections in organ transplantation.
- To discuss the need for improved screening assays to enhance transplant safety.
Main Methods:
- Review of existing literature on donor-derived infections in organ transplantation.
- Analysis of current microbiological screening practices and their limitations.
- Examination of reported cases of infection transmission through organ grafts.
Main Results:
- Microbiological screening protocols for organ donors vary significantly worldwide.
- Both expected and unexpected infections have been transmitted through organ transplants, often identified through recipient clusters.
- Data on the incidence and presentation of donor-derived infections are limited, especially for common screening assays.
Conclusions:
- Absolute prevention of donor-derived infections in organ transplantation is currently not achievable.
- Improvements in screening technologies are essential to minimize infection transmission risks.
- Enhanced microbiological surveillance and assay development will increase the safety of organ transplantation.
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