The risk of transmission of infection through transplantation is well recognized (40) and cannot be completely eliminated, but processes and systems must be in place to ensure that overall risks are kept as low as reasonably possible, whilst still facilitating maximum clinical benefit from transplantation. Balance of risk-benefit is unique to each specific situation and is ultimately a responsibility of the transplanting team to consider them, with due involvement of and consent from the recipient. The transmission of infections to recipients of solid organs, tissues, and corneal grafts is well documented. The risk of infection also exists in association with blood transfusion, but is generally considerably smaller through the screening procedures, deferrals and testing.
13 HARM TO RECIPIENT - INFECTIONS
A wide spectrum of viruses, bacteria, fungi and parasites have been associated with donor-derived infection, with transmissibility depending on several factors, including the type of graft, processing of the graft, and interdependent donor and recipient factors.
The recognition and full evaluation of potential allograft-associated infections is fundamental in the planning of prevention of disease transmission as well as mitigation of complications in recipients, when transmission occurs. Steps involved and interplaying factors include:
- Recognition on the part of clinicians that allograft-derived infection may occur in recipients and that, as such, requires careful microbiological evaluation.
- Clarity on mechanisms available for mandatory and timely reporting of suspected transmission events to the appropriate procurement organizations, tissue and blood
establishments and other competent or public health authorities.
- Promotion of a “culture of safety and quality” that focuses on the prevention of transmission of inadvertent disease and improvement in outcomes in recipients rather than punitive approaches.
- Coordination of exchange of information between public health authorities, competent authorities, clinical centers, patients, tissue and organ procurement groups and blood establishments.
- Development of standard protocols for the investigation of transmission events to expedite management of other recipients possibly impacted by the exposure to a common source of infection.
- Agreement on the optimal panel of clinical microbiological assays for use in screening eye, organ, blood and tissue donors based on the SOHO procured, post- procurement processing, and the expected use of the MPHO. Flexibility must exist in the specific testing paradigms to allow for shifts in microbiologic epidemiology and variations in endemic infections. Decisions must be made regarding the types of assays to be performed and the sensitivity and specificity of each assay. This must be informed by local epidemiology and risk assessment.
- Collection of epidemiologic data to inform trends, patterns and future guidance and policy.