Transplant patients should know risks

CHICAGO (Reuters) - New guidelines are needed to informpeople about the risks of organ transplants after four organrecipients in Chicago got HIV and hepatitis C from a singledonor last year, U.S. doctors said on Wednesday.

While tests initially showed the organs to be free frominfection, the donor was known to have had a high risk ofinfection with the human immunodeficiency virus, which causes

AIDS.

The cases were the first incidence of HIV infection fromorgan donation in 15 years and have stirred debate about how tobest inform people of the risks of transplants.

"This is an issue that goes far beyond those people'sunfortunate circumstances," said Dr. Scott Halpern of theUniversity of Pennsylvania School of Medicine, who makes thecase for new guidelines in the New England Journal of Medicine.

"It is applicable to all patients seeking organ transplantsregarding what they have a right to know and when they have aright to know it," Halpern said in a telephone interview.

Halpern said current guidelines do not adequately protectpatients' rights to make fully informed decisions.

He and colleagues propose the United Network for OrganSharing or UNOS, which sets U.S. policy for organ donation,create guidelines to disclose "all foreseeable risks" oftransplant surgery when a person is placed on the organtransplant list.

This would give patients the right to opt out of receivinghigher-risk organs, including organs from people who are atrisk for infectious diseases.

Halpern said currently, if an organ becomes available and asurgeon is aware that it came from a high-risk donor, he or shewould disclose that at the time of the transplant.

"That creates a whole host of problems, including inequityand the potential for discrimination," he said. And it wastesprecious time, reducing the chances that someone else might beable to use that organ, he said.

CHOOSING UP FRONT

Instead, Halpern thinks people should be told of the risksup front and indicate whether they would accept a riskier organor only one that is from a lower-risk donor.

Halpern and colleagues said this would reduce theopportunity for people to "cherry pick" the best organs, or toonly decline an organ from someone who was at high risk for HIV-- a group that includes homosexual men, people who have beenin prison and injectable drug abusers.

Halpern said telling patients about HIV risk, withoutdisclosing risks about other diseases like high blood pressure,might feed into social biases.

"Because organs are so scarce and there is such a demandand the people who are getting them are in such need, theemphasis has been on increasing the number of donors andimproving access to the organs and making sure there is fairdistribution," Dr. Matthew Kuehnert, who oversees organ safetyat the U.S. Centres for Disease Control and Prevention, said ina telephone interview.

"What hasn't been emphasized is the patient safety part ofit about what are the risks of transmitting disease. It'sevents like (the Chicago cases) that force us to take a look atit," Kuehnert said.

Joel Newman, a spokesman for UNOS, said the cases inChicago were a "galvanizing moment" for the transplantcommunity.

He said UNOS is working with the CDC to improve the way ittalks to potential transplant recipients about all of the risksassociated with organ donation.

(Editing by Maggie Fox)