Education Corner – Serology Testing for Deceased Organ Donors

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SEROLOGY TESTING FOR DECEASED ORGAN DONORS
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Serology Testing Basics

Why test donors? Donor screening for infectious diseases helps prevent unintentional disease transmission to recipients. It is also used to anticipate potential recipient infection and treat the recipient post-transplant.

What is tested? Testing kits are used to detect antigens, antibodies, or viral nucleic acid (RNA or DNA) found in the donor serum (liquid component of the blood).

  • Antigen: A substance that reacts with antibody molecules and antigen receptors on lymphocytes

  • Antibody: A blood protein produced in response to a specific antigen

  • Viral Nucleic Acid: Genetic material that can be detected early in the process

OPTN regulations on serology and infectious disease testing

The Organ Procurement and Transplant Network (OPTN) policy requires infectious disease testing on all deceased organ donors from non-hemodiluted blood samples, when available, using an FDA-approved hemodilution calculator. If a non-hemodilution blood sample is not available, hemodiluted blood may be used for testing. In these circumstances, the donor must also be considered PHS increased risk for disease transmission and HIV Ag/Ab or HIV NAT tested.

Minimum serology requirements for deceased organ donors

It must be taken into consideration when testing serologies that there is a period of time between a person acquiring an infection and when the serology testing will demonstrate antibodies.

Window Periods

Window periods are the time frame from infection to antibody production which can take a month or longer. During this time frame an antibody screening test may not detect infection even though one is present. Nucleic acid testing can detect a single strain of RNA or DNA from the serum sample and narrows the window period to days-weeks.

Best practice includes screening for HIV and HBV NAT in addition to HCV NAT.

References:

  • Centers for Disease Control and Prevention (CDC). (2013, May 5). Testing for HCV Infection: An Update of Guidance for Clinicians and Laboratorians. MMWR. Morbidity and Mortality
  • Weekly Reports. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/ mm6218a5.htm#tab.
  • Centers for Disease Control and Prevention (CDC). (2018, March 3). HIV Basics. Retrieved from https://www.cdc.gov/hiv/basics/testing.html
  • Hepatitis B Foundation. (n.d.). Understanding your hepatitis B blood tests. Retrieved from http://www.hepb.org/assets/Uploads/ Understanding-Your-Hepatitis-B-Blood-Tests.pdf
  • Organ Procurement and Transplantation Policies, 2.9 Required Deceased Donor Infectious Disease Testing (2018).

Special thanks to Ms. Meghan Stephenson, RN, MSN, CPTC (Director, Transplant Services, Mercy Medical Center, Des Moines, IA, formerly at Iowa Donor Network) for her contribution of this in-service content.

Content Editor: Hedi Aguiar, RN, MSN, CCRN-K, Senior Director of Programs, The Alliance (haguiar@odt-alliance.org)

This Education Corner is available for download. The Alliance grants permission for the distribution and reproduction of this educational communication.

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About the Author:

Corey joins The Alliance with more than ten years of experience in corporate and non-profit fields, having worked in Communications for The Walt Disney Company and most recently, Public Relations for TransLife, the OPO serving Central Florida. He has also been an active board member of Donate Life Florida, serving as state team leader for the Driver License Outreach taskforce. Corey holds a Bachelor of Arts in Communication and Information Sciences from The University of Alabama. In his spare time, he is an avid music and theater enthusiast, enjoys traveling, Crimson Tide Football and serving on the board for several local charities in the Orlando area.
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