A transplant patient contracted AIDS from the kidney of a living donor, in the first documented case of its kind in the U.S. since screening for HIV began in the mid-1980s.
It turns out the donor had unprotected gay sex in the 11 weeks between the time he tested negative and the time the surgery took place in 2009.
In a report Thursday on the New York City case, the Centers for Disease Control and Prevention recommended that organ donors have repeat HIV tests a week before surgery.
"The most sensitive test needs to be done as close as possible to the time of transplant," said Dr. Colin Shepard, who oversees tracking of HIV cases for the New York City Health Department.
The CDC also said would-be organ donors should be told to avoid behavior that can increase their chances of infection.
Living organ donors in the U.S. are routinely tested for infectious diseases such as hepatitis and HIV. But the organization that oversees organ transplants in the U.S. does not have an explicit policy on when such screening should be done. That's left up to transplant centers.
Because of patient confidentiality, health officials released few details about the donor, recipient, their relationship or the hospital where the transplant took place, except to say that it is in New York.
Neither the donor nor the recipient knew he or she had HIV until about a year after the transplant, according to the CDC report.
The recipient developed AIDS, perhaps because he or she was on drugs that suppress the immune system to prevent organ rejection, while the donor did not, health officials said. Both are receiving HIV treatment. Their conditions were not disclosed in the report.
"We don't know how frequently this is happening and we need better surveillance," said Dr. Matthew Kuehnert, a CDC official who co-wrote the report.
HIV infections in a donor or recipient may not be discovered until long after a transplant, and even then, patients and their doctors may not make the connection and report it, health officials said.
In this case, once health authorities were notified late last year, they spent months investigating whether the transplanted kidney was the source of the patient's AIDS infection. Genetic analysis of the virus confirmed investigators' suspicions.
At least one similar U.S. case has been reported in the media. A Florida woman last year filed a lawsuit saying she was infected with HIV through a 2007 kidney transplant from a live donor in Florida. However, CDC officials said they have not been asked to investigate and could not confirm the report.
Before that, Italian doctors reported HIV transmission from a live organ donor in 1989.
Since the 1980s, there has been a confirmed report of a deceased donor's organs spreading the AIDS virus. That happened in Illinois in 2007, when organs from a 38-year-old gay man went to four recipients.
For many years, transplant organizations focused heavily on screening organs taken from the dead, which accounted for the large majority of transplants. But kidneys from live donors are becoming increasingly common. In 1988, about 32 percent of kidney transplants came from live donors. By last year, it was more than 46 percent, according to federal data. Donors generally are relatives or friends.
About 88,000 people are on the kidney waiting list right now, according the United Network for Organ Sharing, a nonprofit organization that manages the nation's organ transplant system for the federal government. The group is developing new nationwide policies for live donors, spokesman Joel Newman said.
Transplant centers have teams that evaluate potential donors and look for physical or psychological red flags. But some would-be donors may find themselves in a quandary: They want to save a loved one's life but are unwilling to reveal that they use drugs, have gay sex or engage in other behavior that raises their risk of HIV.
Some donors may assume they will be tested for every important kind of infection, and think it doesn't matter whether they disclose their risky behavior, Kuehnert said.
CDC officials recommend a HIV test developed in the 1990s that is more sensitive than traditional testing. The more sensitive test can detect HIV within 10 days after the person is first infected. An older test won't detect antibodies to HIV until three to eight weeks after infection. Yet the older tests are more commonly done.