We are writing in regard to a recently published article by Ahn and Cohen documenting the transmission of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) to a liver recipient, 2 kidney recipients, and 1 heart recipient. 1 The authors clearly present the case from their patients' perspective, allowing the transplant community to review many of the facts regarding their care. The authors state in the abstract and in the discussion that the transmission occurred secondary to the donor being within the window period between initial infection and detection of antibodies. This is factually incorrect because it has not been clearly confirmed and hemodilution may have contributed to the lack of detection. To date, confirmatory serologic and molecular testing has been conducted only on residual blood drawn on the donor post-transfusion. Because of legal proceedings, the pretransfusion blood has not had confirmatory serologic or molecular testing. Until this is done, it is impossible to determine whether the negative serologic testing that was reported to the centers at the time of the organ offer represented a true negative because the patient was in the window period or if the blood and fluids that the donor had received prior to specimen collection diluted the sample.
Second, an important recommendation from the 1994 Public Health Services Guidelines is not included in the discussion 2 : the need for posttransplant testing of all recipients of organs from increased-risk donors. This not only is an oversight in the article and in its accompanying editorial 1,3 but also is missing from most discussions on this topic. The guidelines clearly recommend that all recipients of organs from increased-risk donors "be tested for HIV immediately before transplantation and at 3 months following transplantation." This case demonstrates some key issues to guide the testing of recipients. First, the patient, like the other transplant recipients, acquired HCV infection without seroconversion; as such, posttransplant testing should use both