Nucleic Acid Testing of Organ Donors: Is the Glass Half Empty or Half Full?

In this issue of the American Journal of Transplantation, Suryaprasad and colleagues present 3 cases of hepatitis C virus (HCV) transmission from seronegative, nucleic acid test (NAT)–negative donors to solid organ transplant recipients (1). This case series represents one of the greatest contributions to the literature on risk mitigation strategies against donor-derived infections and will most definitely add fuel to the ongoing debate about the benefit of NAT in organ donors. Briefly, all three organ donors had evidence of active nonmedical injection drug use up to the time of the event leading to their demise: Donor 1 was hospitalized due to a heroin overdose; donor 2with evidence of IV track marks on physical exam; and donor 3 with toxicology results positive for opiates. All of the donors had undetectable NAT at the time of initial evaluation: 2 were tested on the second day of hospitalization and one on the fourth day of hospitalization. Subsequent retrospective testing of stored splenocytes or lymphocytes collected during organ procurement detected HCV RNA. Eight of 12 (66.7%) recipients from these three donors acquired a donor-derived HCV infection with testing of the index recipient at day 9, 32, and 66, respectively.