Evaluation and adjustment of screening algorithms for HBV, HCV, HIV and syphilis in an anatomical donation program for undergraduate education

Abstract

Study objectiveUndergraduates and other users of anatomical donors are at risk of exposure to bloodborne pathogens. This study evaluated screening algorithms for hepatitis B and C virus, human immunodeficiency virus and Treponema pallidum during donor allocation and assessed the impact of postmortem time on hemolysis and how hemolysis affects test results and donor discard rate.MethodsFrom 2011‐2018, demographic data of donors, time of postmortem blood sampling, presence of sample hemolysis, serological test results (negative; active infection; false reactive screening test; historic infection; inconclusive; technically impracticable) and the actual donor allocation were collected.ResultsDonors (n=537) had a mean age of 77.53±13.67 year. Nine (1.68%) had test results indicative for active infection for hepatitis B (n=1) and C virus (n=2), human immunodeficiency virus (n=5) and Treponema pallidum (n=1). Negative screenings ranged from 74.67 to 97.58%, depending on the pathogen. Based on the screening algorithms, 479 (89.20%) donors should have been accepted. In practice, a donor acceptance rate of 91.20% was found. Analysis of potential donor allocation interpretation obstacles resulted in simplification of the testing algorithms and addition of a nucleic acid test to increase the reliability for identification of active (acute) human immunodeficiency virus infection. Hemolysis was more common when sampling was performed more than 24 hours after death (p<0.001). Hemolytic samples more frequently showed a reactive or indeterminate human immunodeficiency virus test result (p<0.001). Screening for human immunodeficiency virus and Treponema pallidum was technically more impracticable when hemolysis was present (p=0.042 and p=0.003, respectively). Donors with hemolytic blood samples were more often discarded (46.88%) compared to bodies with non‐hemolytic samples (6.32%) (p<0.001).ConclusionsDespite the use of screening algorithms, many bodies used for undergraduate education have an inconsistent allocation. Simplified algorithms were made and are currently prospectively assessed. Early postmortem blood sampling is key as hemolysis can influence certain test results and donor allocation.