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The Impact of Critical Care Quarantine on the Residual Risk of Unexpected Organ Donor Blood-borne Virus Infection
Martin J Dutch1,2, Robert J Maillardet3, Jonathan C Knott1
1Department of Critical Care, Melbourne Medical School, University of Melbourne, Parkville, VIC, Australia.
Background:
The transmission of undetected infections from organ donors to recipients is a persistent concern in transplantation medicine. Despite nucleic acid testing, some infections, especially those acquired recently, may evade detection. This study aimed to model the effects of critical care interval before screening on the residual risk of undetected infections in organ donors.
Methods:
We modeled the risk of blood-borne virus acquisition in donors using a Poisson process, assuming that the critical care interval carries negligible risk. A continuous probability function was developed using estimates of HIV, hepatitis C virus, and hepatitis B virus incidence, viral doubling rates, and assay performance characteristics from a commonly used triplex nucleic acid screening test.
Results:
Our quarantine-adjusted window period model showed that longer critical care intervals resulted in a decreased quarantine-adjusted residual risk of undetected infections. This relationship was linear for most assay window periods. For example, a typical critical care interval of 2.7 d reduces the residual risk by 43.5% for hepatitis C virus, 22.9% for HIV, and 7.4% for hepatitis B virus. In some clinical situations, the critical care quarantine effect may outweigh intragroup variations in risk behavior. The model also enabled comparisons of different blood collection times.
Conclusions:
The quarantine-adjusted window period model indicates that the critical care interval further reduces the risk of undetected infections in deceased organ donors. This supports and quantifies the impact of screening organ donors as close to retrieval surgery as possible, rather than delaying surgery solely based on the risk of residual infection.
Insights
The critical care interval before organ donor screening significantly reduces the risk of undetected infections. This finding supports timely organ retrieval, minimizing transmission risks for recipients.
Area of Science:
- Transplantation Medicine
- Infectious Disease Epidemiology
- Public Health
Background:
- Undetected infections in organ donors pose a risk to recipients, even with nucleic acid testing.
- Recently acquired infections can evade current screening methods.
- The impact of the critical care interval on infection risk in donors requires further investigation.
Purpose of the Study:
- To model the effect of the critical care interval on the residual risk of undetected infections in organ donors.
- To quantify the reduction in infection risk based on the duration of the critical care interval.
- To inform screening and organ retrieval protocols.
Main Methods:
- A Poisson process model was used to simulate blood-borne virus acquisition in donors.
- A continuous probability function incorporated incidence, viral doubling rates, and assay sensitivity.
- The model estimated quarantine-adjusted window periods for HIV, HCV, and HBV.
Main Results:
- Longer critical care intervals linearly decreased the quarantine-adjusted residual risk of undetected infections.
- A 2.7-day critical care interval reduced HCV risk by 43.5%, HIV by 22.9%, and HBV by 7.4%.
- The critical care quarantine effect can be more significant than individual risk behaviors.
Conclusions:
- The critical care interval demonstrably reduces the risk of undetected infections in deceased organ donors.
- Screening organ donors as close to retrieval as possible is supported by this model.
- Delaying organ retrieval solely due to infection risk may be unnecessary given the quarantine effect.
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