Provider Response to a Rare but Highly Publicized Transmission of HIV Through Solid Organ Transplantation | HIV | JAMA Surgery | JAMA Network
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Original Article
January 2011January 17, 2011

Provider Response to a Rare but Highly Publicized Transmission of HIV Through Solid Organ Transplantation

Author Affiliations

Author Affiliations: Division of Transplantation, Department of Surgery (Mss Kucirka and Ros and Drs Montgomery and Segev) and Division of Infectious Diseases, Department of Medicine (Dr Subramanian), School of Medicine, and Department of Epidemiology, School of Public Health (Dr Segev), The Johns Hopkins University, Baltimore, Maryland.

Arch Surg. 2011;146(1):41-45. doi:10.1001/archsurg.2010.303
Abstract

Objective  On November 13, 2007, the first reported case in 20 years of HIV (human immunodeficiency virus) transmission from a Centers for Disease Control and Prevention high-risk donor (HRD) made national headlines. We sought to characterize change in the practice of transplant surgeons resulting from this rare event.

Design  We performed a survey between January 17, 2008, and April 15, 2008, assessing attitudes and practices of transplant surgeons regarding HRDs. Descriptions of changes in practice after the event were categorized, and associations between responses and regional-, center-, and physician-level factors were studied.

Setting  Transplant centers in the United States.

Participants  Four hundred twenty-two transplant surgeons in current practice.

Main Outcome Measure  Changing practice following the 2007 HIV transmission event.

Results  Among surgeons who responded to the survey, 31.6% changed their practice following the event. Also, 41.7% decreased use of HRDs, 34.5% increased emphasis on informed consent, 16.7% increased use of nucleic acid testing, and 6.0% implemented a formal policy. Ranking fear of being sued or hospital pressure as important disincentives to HRD use was associated with more than 2-fold higher odds of changing practice. Ranking medical risks of HIV as an important disincentive was associated with 8.29-fold higher odds of decreasing HRD use.

Conclusion  The most common responses to this rare event were avoidance (decreased HRD use) and assurance (increased emphasis on informed consent) behaviors rather than patient safety measures (increased use of nucleic acid testing and implementation of formal policies), suggesting that fear of legal or regulatory consequences was the biggest driver of physician decision making and that the current litigious environment is failing to protect patient interests.

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