Inquiry ordered after organ donor found to have CJDBMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7121.1485 (Published 06 December 1997) Cite this as: BMJ 1997;315:1485
An inquiry has been ordered into the screening system for organ donors in Britain after a woman who donated eye tissue to three patients was found to have been infected with Creutzfeldt-Jakob disease (CJD).
The case has highlighted a weakness in the current system, which can result in tissue infected with CJD being used in transplants before a donor's infected status becomes apparent. However, both CJD specialists and the government say that any such circumstances are likely to be extremely rare and the overall risks of the fatal brain disease being transmitted in this way are low. Mrs Marion Hamilton, 53, from Stirlingshire, died in February of inoperable lung cancer but she also had neurological problems that led to a postmortem examination at Stirling Royal Infirmary. Brain tissue was sent to the National CJD Surveillance Unit in Edinburgh because doctors suspected that she may have had the classic form of CJD.
Despite these fears, which were confirmed last week when the final results were produced, no action was taken to prevent Mrs Hamilton's corneas and sclera being used in transplants. The three patients who received this tissue have now been informed.
The government's inquiry is expected to focus on the decision to allow Mrs Hamilton's eyes to be used for corneal transplants when there were concerns that she may have CJD. Scotland's health minister, Sam Galbraith, said: “We need to know whether indications about the donor's condition at the time of her death should have led to more questions about the use of her eyes for transplantation.”
Sandra Galloway of the CJD Support Network, a group established to help families who have experienced CJD, raised wider fears that CJD infected organs are being transplanted without anyone knowing about it. “Everyone involved with CJD feared this would happen. It would be so easy for someone carrying a donor card to be incubating the disease without knowing it.”
Checks are carried out on organs and other tissues donated for use in transplant procedures in Britain to ensure that they are not infected with viruses such as HIV and hepatitis. But Dr James Ironside of the National CJD Surveillance Unit said that in the absence of an effective screening test for CJD, it was difficult to see how a system could be created to eliminate completely the risk of infection. “We cannot screen for CJD the way we can for HIV, and as a result we cannot tell if someone is incubating the disease. However, if someone dies with clinical features of the disease, then obviously these patients should not be admitted into the organ donation programme.”
Mr Galbraith has called on doctors who are assessing the suitability of patients as organ donors to be aware of the possible risk of transmitting infectious diseases. “In the light of this case, the government are exploring urgently what steps can be taken to reduce even further the risk of something like this happening,” he said.