Professionals who zealously spread the gospel of organ and tissue transplantation agreed yesterday that they cannot eliminate the possibility that an infected donor will again transmit the AIDS virus to recipients of his or her organs. But, they insist, the chances are slim.
The case of the Virginia donor -- and the three recipients who died of AIDS after receiving his organs -- represents the nightmare that was always lurking as a possibility.
Now that it has happened, experts say, the public must realize that the chance of contracting the AIDS virus from donated organs or tissue is extremely remote -- possibly as slim as one chance in 100,000 -- but won't disappear until improvements in medical testing are made.
"You do the best of what you can within the limits of what is possible," said Molly Dice, an official with the Baltimore-based Transplant Resource Center of Maryland, which coordinates organ and tissue transplants throughout most of the state.
"It's not like products on an assembly line where you have total control over what's produced," she said. "We control for everything we can control for. Unfortunately, there are some variables that are out of our control."
Like the Virginia donor, all prospective donors in Maryland and elsewhere are tested for antibodies to the AIDS virus. But people ordinarily take up to three months to produce those antibodies -- and a California study once discovered people who took more than three years to develop theirs.
Such long delays in producing antibodies are thought to be rare, but even a three-month lag creates a window through which infected donors can slip undetected. Then, their organs and tissues can fan out to scores of recipients.
News that a 22-year-old homicide victim donated his heart, kidneys, liver, pancreas, thigh bone, hip joints, knee ligaments, tendons, corneas and other tissues to more than 50 recipients did not surprise people in the transplant field.
"Fifty? That's not unusual, given the amount of skin that can be recovered, the number of bones that can be recovered, the tendons and ligaments," Ms. Dice said.
More than half the 112 people who donated through the Transplant Resource Center last year supplied more than one organ or tissue, she said.
Today, donated skin helps repair the charred bodies of burn victims. Whole bone and bone powder help heal people with orthopedic injuries and bring cosmetic benefits to children with facial deformities.
Hip replacements come from human donors, not just factories that turn out synthetic replicas. Donated ligaments and tendons bring relief to people hobbled by damaged knees. Corneas restore vision to the blind.
Organ and tissue banks try to screen out donors such as intravenous drug users or homosexual men whose lifestyles have placed them at risk for contracting the AIDS virus. Transplant coordinators glean histories from grieving family members in the hospitals where their loved ones died.
"This case underscores the fact that we have to be extraordinarily careful in taking the social history of the donors," said Dr. Stephen Bartlett, director of transplantation at the University of Maryland Medical Center.
Some tissues such as skin and bone are irradiated before they are frozen, or freeze-dried in a process that utilizes alcohol, according to David Kappus, executive director of the Maryland transplant center. These methods should kill any virus.
But vital organs cannot be subjected to these treatments. They are flushed to remove blood, but never sterilized. And most tissues are fresh-frozen and then stored, a method that would not necessarily destroy the AIDS virus, he said.
"The preference of the orthopedic surgeons and people who use these tissues is for fresh-frozen, so the tissue is not altered in any way," Mr. Kappus said. "The texture and continuity of the bone is much preferred."
The only sure method to eliminate any risk would be a fast and low-cost test to detect the AIDS virus itself rather than slow-to-develop antibodies, he said.
The only virus-detecting test now on the market is extraordinarily expensive and takes longer than the few hours hospitals have to remove and transplant an organ.