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CDC's proposed guidelines for transplants say two sex partners is too many for top-notch organ donors

CDC's proposed guidelines for transplants say two sex partners is too many for top-notch organ donors
Proposal would add sexually active group to high-risk category; experts fear guidelines too restrictive

BY Rheana Murray

Monday, December 5 2011, 3:50 PM
Organ Donor drive. File photo dated 11/04/10 of a general view of a person signing up for an NHS Donor card. Anyone applying online for a driving licence will be required to answer a question regarding organ donation from today. Issue date: Monday August 1, 2011.

Those who sign an organ donor card and have had sex with two or more people in the past year would be considered high risk for transmitting hepatitis B and C in addition to HIV, according to proposed guidelines from the Centers for Disease Control and Prevention.

If you’re not monogamous, you’re not an ideal organ donor, according to a new set of health guidelines proposed by the Centers for Disease Control and Prevention.

Under the proposed policy, people who’ve had sex with two or more people in the past year will be considered high-risk for transmitting HIV, hepatitis B and hepatitis C, but transplant experts are arguing that the standards are far too limiting.

“With the new guidelines, every college student in America will be high-risk,” said Dr. Harry Dorn-Arias, a transplant surgeon at the University of Virginia, according to msnbc.com. “Right now, it’s probably a prostitute or a guy with a needle in his arm. Next time, it will be just a young guy.”

The guidelines could limit the number of available organs by discouraging potential donors who are hesitant to have their sexual history classified as “risky,” especially if the transplant situation involves a family member, Dorn-Arias warns.

“If you were going to give your organ to your mom or dad or sister, you’re going to be ashamed of that,” he said. “You’re either going to say no, or you’re going to lie.”

The policy could also deter patients in need of a transplant from accepting organs that are labeled “high-risk,” says Tracy Giacoma, transplant administrator at the University of Kansas Hospital, according to msnbc.com.

“If you have a donor that’s 19 years old and he had multiple partners, we’ll have to tell the recipient, ‘This is a high-risk organ,’” she said.

“It’s probably going to triple what we consider high risk at this point. It may scare patients off from taking these organs. More patients may die because they don’t take these organs.”

The CDC says the proposition is designed to give transplant-seekers as much information as possible about an organ they might take.

“It’s geared for the patient, so the patient knows as much as they can about the organ being transplanted in them,” said Dr. Matthew J. Keuhnert, director of the center’s office of Blood, Organ and Other Tissue Safety, to the network.

“Our priority here is safety,” he added. “Patients should know if they’re getting an organ at elevated risk.”

Between 2007 and 2010, the CDC confirmed a dozen cases of unexpected transmission of infections in transplant cases.

The proposed guidelines would be the first major update since 1994 to the CDC’s Public Health Service policies for preventing transmission of HIV through human tissue and organs. It adds hepatitis B and hepatitis C to the list of viruses that donors must be tested for, while the current policy mandates only an HIV test.

The guidelines can be viewed at www.regulations.gov.

Read more: http://www.nydailynews.com/life-style/health/monogamy-doctor-ordered-organ-transplant-donors-cdc-article-1.987085#ixzz1flErEDVg

See:  http://www.nydailynews.com/life-style/health/monogamy-doctor-ordered-organ-transplant-donors-cdc-article-1.987085

My opinion is these new guidelines, if implemented, are going to result in far more harm than good.

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Avatar universal
The CDC is full of [email protected] !!!!!!! about this....ARRRGHHHHHH !!!!!!!!!!!

We need more liver donors, not less for cripes sake.....

This makes me so angry.
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419309 tn?1326503291
My thoughts exactly.  

Hopefully *enforcement* will be near impossible, though.  What does the CDC expect doctors to do to abide by these ridiculous guidelines, I wonder?  Swab every potential donor for alien DNA?!?... Spot test for sexual residue like they do for drug residue?!? And what about the recipient?!? How about their risk for infection?!? What are we going to see next, a restriction on sexual activity of TP recipients?!?

I'm inclined to think the survey is tainted...  brings the researchers and the data into question when it is qualified with the statement:
"When the researchers changed the format in which they presented the information, they found a significant impact on patient preferences."... not to mention the likelihood that suggestive reasoning might be impacting those with hepatic encephalopathy.

Marching into a corner so I can mutter unintelligibly rude things under my breath at the CDC and their Public Health policy makers. ~eureka
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163305 tn?1333668571
I figured it out~only nuns get to be donors.
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179856 tn?1333547362
What a bunch of hogwash BS the exact opposite campaign that is needed in the first place.

BTW I would take any liver over a liver of someone who works at the CDC God knows that THOSE people are infected with.  They should put that in their pipe and smoke it!!!!!!!!

Anger just boiling anger right now.........
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Avatar universal
I agree.
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163305 tn?1333668571
I think the idiots are running amok.
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163305 tn?1333668571
Whoops, could my donor's liver be recalled because she had more than 2 sex partners? Could this the beginning of the repo police?

It seems to me the world is turning more and more into weird dark science fiction.
No compassion, nothing but the bottom ($) line.
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Avatar universal
It just perpetuates this misconception that sexual transmission is a big risk for HCV. When the CDC is promoting this stuff and incorporating it into its guidelines I think we have a problem.

Hers is another article which seems relevant.

Patients 'Shopping' for a Liver Want Only the Best

Organ quality is important to patients, but not well understood, when "shopping" for a liver to transplant, according to a recent survey.

An initial survey of 10 people on the waiting list at a major transplant center found a very poor understanding of the spectrum of organ quality. Most tended to say that livers were either good or bad and that the facility would only offer them the very best available, reported Michael L. Volk, MD, and colleagues from the University of Michigan in Ann Arbor.

Using these findings as a base, a larger group of 95 people was surveyed. The mean risk of acceptable graft failure was 32% at three years after transplantation, the researchers wrote in the December issue of Liver Transplantation.

Despite being told that stringent standards would lower the number of livers available, 58% would accept only livers with graft failure estimates of 25% or less at three years and 18% would only accept those with the lowest possible risk (19% at three years).

The quality of donor livers can vary greatly depending on age, cause of death, steatosis, and ischemia time; those factors can make the difference between 20% and 40% rates of graft failure three years after transplantation, the authors noted in their introduction.

In addition, the quality of donor livers is expected to decrease over time, both because the population is aging and because more people have experienced a stroke as a cause of brain death, the authors noted. As well, a federally funded group is promoting the use of extended criteria donor organs, which will expand the donor pool but also will increase the chance of graft failure.

As a result, discussions of organ quality with patients are more essential than ever, but hard to make time for in a busy clinic. "It is challenging to discuss the use of high-risk organs with patients, in part because of the lack of information on how patients view the topic," wrote the authors.

To find out more about how patients were thinking about these issues, the investigators conducted a two-part study. The first part consisted of a semi-structured interview of 10 patients on the waiting list. The questions at the start were open-ended, but as they continued, they became more focused on finding participants' preferences based on their understanding of organ quality.

The second part consisted of three sections on a computerized survey. They looked at education about the differences in liver quality and what that meant when considering graft failure, patient preferences about the level of risk they would accept, and 10 covariates the researchers thought might influence patients' decision-making.

A bias against lower-quality organs occurred when participants were asked to decide between staying on the list with a 20% chance of dying in three years or accepting a lower-quality organ with a 20% chance of dying but an improved quality of life. Despite having the logically correct answer to accept the liver, 42% still opted to stay on the list.

When the researchers changed the format in which they presented the information, they found a significant impact on patient preferences.

Those who were first presented a graph showing the best possible outcome would accept risk of failure up to 25% on average. Those who saw a graph with the 25% risk of failure (the average for the center) would accept up to a 29% risk on average (P=0.001).

Some participants were presented with a pie-chart pictograph showing graphically what percentage of organs would fail at a given risk level. The initial average failure risk they would accept at three years (28%) increased to 32% once they had seen the pictograph (P=0.003).

Among the 67 who wanted only organs with a 25% or less chance of graft failure, 19% would accept higher risk after the feedback was given. Conversely, only 7% of those who would accept organs with more than 25% failure risk reduced their risk tolerance.

Among the demographic and clinical covariates examined, only sex was associated with risk preference.

After feedback was given, men preferred organs with a lower failure risk than women (29% versus 35%, P=0.04). Only belief in control was significant among the psychological measures, with patients having a more external locus of control more likely to accept higher-risk organs (P=0.04).

Twenty patients were surveyed again after a mean time of 16 months (range 6 to 30 months). As a group, their risk preferences had not changed significantly, with mean acceptable graft failure risk being 34% initially and 33% at the second instance (P=0.3).

But as individuals, the preferences were not stable, with only a modest correlation between initial and re-approached values (Spearman's P=0.24).

"This study of patient decision-making about organ quality has three main findings," the authors concluded. "First, many patients entered discussions about organ quality with an inherent bias against the acceptance of organs with higher risk of graft failure. Second, risk tolerance was highly variable between individuals and not particularly stable over time. Third, an individual patient's risk tolerance was associated with sex and beliefs about his or her control over his or her health, and not with the severity of liver disease."

See: http://www.medpagetoday.com/Transplantation/LiverTransplantation/29996?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&eun=g235671d0r&userid=235671&email=***@****%CE%BC_id=

Overall, it looks a little grim for future liver transplant candidates.

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Avatar universal
"My opinion is these new guidelines, if implemented, are going to result in far more harm than good."

Well i agree with you Mike, they must have to much time on their hands to think up this silly sh!t...... What we need is more organ donors, not less. Theres no more higher risk then dying because of lack of donors.

If the time comes that i need a liver, i'm not going to be to dam pickie

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