For example, HIV can take up to three months to appear positive in testing. Because of this, the study’s authors said groups with a higher risk of contracting HIV than the broader population are often rejected from organ donation without viral screening.
The study’s authors found that if donors from these groups were accepted, subject to antibody and nucleic acid testing, it could expand the donor pool in NSW by about five donors per year – providing organs to as many as 30 additional recipients.
“Nucleic acid testing is not uniformly available across Australia, but its importance for estimating residual infection risk is clear,” the authors wrote.
Risk of infection ‘low in absolute terms’
The researchers, from the University of Sydney, the University of NSW, NSW Health Pathology, the Royal Prince Alfred Hospital and the Centre for Transplant and Renal Research at Westmead Hospital, analysed data from MEDLINE, government and agency reports, the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine conference abstracts, the Australian New Zealand Clinical Trial Registry, National Health and Medical Research Council grants and others.
They found that even among the groups most at risk of carrying a blood-borne virus, that risk is “low in absolute terms”, said lead author Karen Waller.
Men who have sex with men, for example, have the highest residual risk of HIV – but in Australia this risk is only about one in 10,000 people with negative test results. For hepatitis B and C, injecting drug users were found to be the most at risk; but the risk was still under one per cent.
Dr Waller said that given vaccines and cures exist for hepatitis B and C respectively, these potential donors “should also be considered”.
The Organ and Tissue Authority’s national medical director, Helen Opdam, said organ donation in Australian hospitals is “consistent with world’s best practice, led by specialist donation teams of doctors and nurses.”
However, donation is “an infrequent event”, she said. “Only around two per cent of people who die in hospital can become organ donors, which highlights why it is so important that we optimise every donation opportunity.”
With around 1400 Australians currently waiting for a transplant and another 11,000 on dialysis, Dr Opdam said “the biggest risk to people in need of a transplant is not receiving one.”
Dr Opdam said testing for blood-borne viruses “is a routine part of the donation assessment process, and, in many circumstances, can reliably exclude the potential donor from having these infections.”
But if the behaviours associated with contracting such infections have occurred recently “or if such recent risk behaviours cannot be excluded from information available from family and friends of the person,” then she said the tests cannot be fully relied upon.
Darryl O’Donnell, chief executive of the Australian Federation of AIDS Organisations, said all avenues to safely increase organ donation should be explored as prevention, diagnosis and treatment of HIV and other blood-borne illnesses improves.
“The accuracy and speed of HIV tests has improved substantially over the last decade. People at higher risk of HIV, such as gay and bisexual men, are testing in record numbers, while new prevention methods such as PrEP are making serious inroads against transmission rates,” he said.
“This study provides new evidence authorities should consider to ensure we don’t exclude people who could safely donate organs that might improve or even save someone’s life.”
Jenny Noyes is a journalist at the Sydney Morning Herald. She was previously a writer and editor at Daily Life.