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Taiwan hospital uses HIV-infected organs in five transplants

A hospital in Taiwan has admitted to transplanting HIV-infected organs from one donor into five different patients.

National Taiwan University Hospital
National Taiwan University Hospital
Image: Allen Timothy Chang via wikimediacommons

ONE OF TAIWAN’S best regarded hospitals has admitted to mistakenly transplanting HIV-infected organs into five patients.

The hospital said the errors occurred after a hospital staffer misheard the donor’s test results by telephone.

The five are now being treated with anti-AIDS drugs, an official at National Taiwan University Hospital in Taipei said today. The official spoke on condition of anonymity because she is not authorised to deal with the media.

The hospital said on its website over the weekend the mistake occurred because a transplant staffer believed he heard the English word “non-reactive” on the donor’s standard HIV test, while the word “reactive” was actually given.

The information on the test result was given over the telephone and was not double-checked, as required by standard operating procedures, the hospital statement said.

We deeply apologise for the mistake,” the hospital said.

The Health Department will look into the mistaken transplants and decide on possible penalties for NTUH, department official Shih Chung-liang said. If negligence was found to have caused the blunder, Shih said the hospital may have to suspend its transplant programs for up to a year in addition to unspecified fines.

Organ donor

The donor was a 37-year-old man who fell into a coma on August 24 and his heart, liver, lungs and two kidneys were transplanted to five patients on the same day. The heart transplant was conducted at another hospital, while the four other transplants were conducted at NTUH, according to NTUH.

The donor’s mother, who was not identified, told cable news stations that she felt terrible about the transplants and had not been aware of her son’s ailment. She said he died after “falling from a high spot,” without providing details.

Yao Ke-wu, who heads the health department of Hsinchu city, where the donor resided, decried the NTUH transplants as “appalling negligence.”

He said NTUH staffers could have avoided the mistake by asking his department about the donor’s medical history in advance, and deplored that such inquiries were not mandatory in Taiwan.

Yao said the five organ receivers will very likely contract HIV, and their anti-AIDS treatment will be further complicated because they also have to take medication to modify rejection of the new organs.

The five recipients are all Taiwanese. NTUH is among about a dozen well-equipped and highly-respected Taiwanese hospitals offering organ transplants.

There are also concerns among the physicians and nurses who conducted the transplants that they too may contract HIV. Medical staffers routinely take protections against bodily fluids during surgeries, but some experts also warned needle and other accidential cuts could still expose them to HIV.

Lee Nan-yao, a physician with the National Chengkung University Hospital, which performed the heart transplant, told the United Daily News that some physicians and nurses who had conducted the transplant “were depressed and on the verge of panic.”

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Comments (7 Comments)

  • Brian M 29/08/11 #

    As if being in the position of needing a transplant wasn’t bad enough then you end up getting an infected organ. Words cannot describe the pity I have for these poor people

    Reply
  • After the 7/7 bombings in London the coroner criticised the use of terminology such as :
    Dynamic risk assessment (making your own decisions)
    ■ Rich situational awareness (knowing a lot)
    ■ National role maps (list of job titles)
    ■ Interface (talk to colleagues) etc

    maybe if the answers were Yes or No instead of reactive or non-reactive, the mistake might not have been made.
    Keep it simple

    Reply
  • shocking

    Reply
  • You’d think the organs, when package and being delivered, would be properly labeled with ““non-reactive” or “reactive” since it seems so important. I have no idea what those mean but it seems, in this case, that it means HIV infected organs, or Non-HIV infected organs.

    I do hope the hospital will take care of those 5 people and give them all the drugs they need.

    Reply
  • It must have been a very shocking and life changing experience! Imagine, contracting HIV is not a simple sore throat that is self-limiting. The disease itself disables the immune system. That means that something like the common cold can be fatal for someone with HIV, and worst, it may likely to develop into AIDS after a decade.

    What went wrong? Any health provider must be aware that patient’s safety is the top priority. Health care professionals, may it be physicians, nurses or other healthcare team members must be PATIENT-CENTERED.

    Now, can this be a malpractice case? Will they be held accountable? This reminds me of the article written by Mr. Haskell, a popular lawyer in Spokane WA that has won a bunch of million dollar legal claims. Here it is: Medical Mistakes — A Primer on the Basics of Medical Malpractice. That will supplement everybody with information about medical issues, and further widen horizons about medical malpractice.

    To conclude, not all claims connected with clinical practice are MEDICAL MALPRACTICE. There are so called legal aspects that must be considered before concluding the case even this exhibited issue of the infected organs. I hope this will not accrue because if not, it is not a good sign for the health institutions. They should be considered a safe place for the sick and not a place for acquiring more diseases.

    Reply
  • In other news, 5 Taiwanese people who would otherwise have died were given organs allowing them to have far longer, far more normal lives.

    Baby. Bathwater.

    Reply

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