Nucleic Acid Amplification Tests Testing Research Articles

Screening Donors of Solid Organs for West Nile Virus: First, Do No Harm!

Departments of Pathology, Medicine and Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia Correspondence: Dr Kevin Forward, Departments of Pathology, Medicine and Microbiology and Immunology, Dalhousie University, 5788 University Avenue, Room 315, Mackenzie Building, Halifax, Nova Scotia B3H 1V8. Telephone 902-473-4109, fax 902-473-4432, e-mail kevin.forward@cdha.nshealth.ca Received and accepted for publication September 29, 2004. Health Canada has recently published guidelines that promote testing donors of tissues and perfusable organs for West Nile virus (WNV) using nucleic acid amplification testing (NAT) (such as polymerase chain reaction) (1). It is my belief that the rationale underlying these guidelines is fundamentally flawed and that these guidelines will harm (or already have harmed) patients. My primary concerns relate to polymerase chain reaction testing of donors of perfusable organs. There is no doubt that transplanted organs can transmit WNV and that infected recipients may experience particularly severe outcomes (2). The Health Canada guidelines suggest that all donors should have NAT testing performed before transplantation. These guidelines do not suggest that such testing be considered in the context of disease activity (either local or seasonal epidemiology). For instance, under these guidelines, a donor who has not left Manitoba for months should be tested for WNV at midnight on New Year’s Eve. The failure to consider the pretest probability of active infection, when combined with a lack of knowledge of the performance characteristics of available tests (which are licensed and have not been formally evaluated for this indication), is a recipe for disaster (eg, discarding life-saving organs).