Organ Donor Infectious Disease Organ Donor Infectious Disease Testing EducationTesting Education

UW Health OPOUW Health OPO

July 2009July 2009

UW health OPO performs the following UW health OPO performs the following infectious disease testing in compliance with infectious disease testing in compliance with

the United Network for Organ Sharing the United Network for Organ Sharing (UNOS) standards for every donor:(UNOS) standards for every donor:

• HIV I/IIHIV I/II• HTLV I/IIHTLV I/II• Anti-HBc (Hepatitis B Core)Anti-HBc (Hepatitis B Core)• HBsAg (Hepatitis B surface antigen)HBsAg (Hepatitis B surface antigen)• HCV (Hepatitis C)HCV (Hepatitis C)• VDRL/RPR (Syphilis)VDRL/RPR (Syphilis)• CMV (Cytomegalovirus)CMV (Cytomegalovirus)• EBV (Epstein-Barr Virus)EBV (Epstein-Barr Virus)

Current ChallengesCurrent Challenges

• Early 2008 – Abbott labs discontinued Early 2008 – Abbott labs discontinued FDA approved kit used by UWHC for FDA approved kit used by UWHC for Hepatitis B, Hepatitis C & HIVHepatitis B, Hepatitis C & HIV

• UW Health OPO given exemption by UW Health OPO given exemption by UNOS to perform diagnostic testing, UNOS to perform diagnostic testing, CentaurCentaur

Current StatusCurrent Status

• Donor serological testing is generally done at Donor serological testing is generally done at UW via diagnostic method.UW via diagnostic method.

• Only exception is in the case of a potential islet Only exception is in the case of a potential islet donor. These panels are sent to BCW donor. These panels are sent to BCW (BloodCenter of Wisconsin) for FDA approved (BloodCenter of Wisconsin) for FDA approved serologies.serologies.

• July 1, 2009 – All donor serological testing will July 1, 2009 – All donor serological testing will be done at BCW, including NAT and WNV. be done at BCW, including NAT and WNV.

• The only blood testing done at UW will be ABO The only blood testing done at UW will be ABO verification, EBV (send out) and HLA.verification, EBV (send out) and HLA.

BloodCenter ofBloodCenter of WisconsinWisconsin

• Open since 1947 and located in Open since 1947 and located in Milwaukee, WI Milwaukee, WI

• On call staff enables donor testing 24 hrs On call staff enables donor testing 24 hrs a day 365 days a yeara day 365 days a year

• Approved for NAT testing on all donorsApproved for NAT testing on all donors

NAT TestingNAT Testing• The industry standard is changing with regard to The industry standard is changing with regard to

infectious disease testing.infectious disease testing.• NAT (Nucleic Acid Testing) detects the genetic NAT (Nucleic Acid Testing) detects the genetic

sequence of the virus, bacterium or parasite that is sequence of the virus, bacterium or parasite that is present in the host as a result of the infection.present in the host as a result of the infection.

• It is used for HIV, HCV, HBV and West Nile Virus.It is used for HIV, HCV, HBV and West Nile Virus.• NAT shortens the window of detection for HIV & NAT shortens the window of detection for HIV &

HCV from approximately 22 days to 5 days and for HCV from approximately 22 days to 5 days and for HBV and WNV to 1 day.HBV and WNV to 1 day.

• Currently 45 out of the 58 OPOs are performing Currently 45 out of the 58 OPOs are performing NAT.NAT.

New ProcessNew Process

• Initial donor blood draw will now need to Initial donor blood draw will now need to be shipped in 2 packagesbe shipped in 2 packages• Package 1—sent to BloodCenter of WIPackage 1—sent to BloodCenter of WI

• 3 7 ml EDTA (lavender) tubes3 7 ml EDTA (lavender) tubes• 2 10 ml serum sample (red top—NOT serum 2 10 ml serum sample (red top—NOT serum

separator) tubesseparator) tubes• Package 2—sent to UWPackage 2—sent to UW

• 4 10 ml ACD (yellow top) tubes4 10 ml ACD (yellow top) tubes• 1 5 or 7 ml lavender tubes1 5 or 7 ml lavender tubes

New ProcessNew Process

• For each bagFor each bag• Affix a label including patient’s first and last Affix a label including patient’s first and last

name, date of birth, date and time of draw and name, date of birth, date and time of draw and initials of person drawinginitials of person drawing

• Place the tubes in a biohazard bag and then Place the tubes in a biohazard bag and then package in a small box or envelopepackage in a small box or envelope

• Write: To BloodCenter of WI on package 1Write: To BloodCenter of WI on package 1• To UW Hospital ER on package 2To UW Hospital ER on package 2

New ProcessNew Process

• Take samples to your ER triageTake samples to your ER triage

• A courier will be arranged to transport the A courier will be arranged to transport the samples from your ER to their destinationsamples from your ER to their destination

• Please call organ procurement coordinator Please call organ procurement coordinator on call with any questions: 608-262-2122on call with any questions: 608-262-2122

New TimelineNew Timeline

• Once blood arrives to BCW serology Once blood arrives to BCW serology testing takes 4-6 hrs to complete; if any testing takes 4-6 hrs to complete; if any results are positive the test needs to be re-results are positive the test needs to be re-run and take an additional 4-6 hrsrun and take an additional 4-6 hrs

• Once blood arrives to UW ER Once blood arrives to UW ER • ABO takes under an hourABO takes under an hour• EBV needs to be sent out and results arrive in EBV needs to be sent out and results arrive in

5 to 7 days5 to 7 days• HLA (tissue typing) takes about 4 hoursHLA (tissue typing) takes about 4 hours

Thanks for your Thanks for your assistance!!assistance!!