Provider response to a rare but highly publicized transmission of HIV through solid organ transplantation.
OBJECTIVE
On November 13, 2007, the first reported case in 20 years of HIV (human immunodeficiency virus) transmission from a Centers for Disease Control and Prevention high-risk donor (HRD) made national headlines. We sought to characterize change in the practice of transplant surgeons resulting from this rare event.


METHODS
We performed a survey between January 17, 2008, and April 15, 2008, assessing attitudes and practices of transplant surgeons regarding HRDs. Descriptions of changes in practice after the event were categorized, and associations between responses and regional-, center-, and physician-level factors were studied.


METHODS
Transplant centers in the United States.


METHODS
Four hundred twenty-two transplant surgeons in current practice.


METHODS
Changing practice following the 2007 HIV transmission event.


RESULTS
Among surgeons who responded to the survey, 31.6% changed their practice following the event. Also, 41.7% decreased use of HRDs, 34.5% increased emphasis on informed consent, 16.7% increased use of nucleic acid testing, and 6.0% implemented a formal policy. Ranking fear of being sued or hospital pressure as important disincentives to HRD use was associated with more than 2-fold higher odds of changing practice. Ranking medical risks of HIV as an important disincentive was associated with 8.29-fold higher odds of decreasing HRD use.


CONCLUSIONS
The most common responses to this rare event were avoidance (decreased HRD use) and assurance (increased emphasis on informed consent) behaviors rather than patient safety measures (increased use of nucleic acid testing and implementation of formal policies), suggesting that fear of legal or regulatory consequences was the biggest driver of physician decision making and that the current litigious environment is failing to protect patient interests.
Department of Surgery, The Johns Hopkins University, Baltimore, Maryland, USA.
Lauren M
LM
Kucirka
R Lorie
RL
Ros
Aruna K
AK
Subramanian
Robert A
RA
Montgomery
Dorry L
DL
Segev
D001291:Attitude of Health Personnel; D003625:Data Collection; D015658:HIV Infections / Q000175:diagnosis / Q000635:transmission*; D006526:Hepatitis C / Q000175:diagnosis / Q000635:transmission; D006801:Humans; D016377:Organ Transplantation / Q000009:adverse effects*; D010818:Practice Patterns, Physicians'; D012307:Risk Factors; D014019:Tissue Donors / Q000600:supply & distribution