What procedures are institutions following to assure that organs intended for transplantation are properly matched for ABO, HLA and other antigens? 

In response to the Feb 19, 2003 report of an error involving heart-lung transplant from an ABO-incompatible donor, a colleague wonders what other institutions do to assure that organs intended for transplantation are properly matched for ABO, HLA and other antigens, as appropriate for the kind of transplantation procedure being done?

The following responses were received.

1. A hospital in Los Angeles requires a blood specimen from the organ donor be submitted at the time of organ receipt in preparation of transplant. The Blood Bank reports the result and the transplant does not proceed until the blood typing of the organ donor matches with the blood type of the recipient. The HLA typing is performed in an another department, and the blood bank is not aware of their policy.

ADDENDA Feb. 24, 2003

2. According to Duke spokesman Richard Puff (USA Today. Feb. 24) a new system of safeguards has been implemented that includes ensuring at least three surgeons match the organ donor's blood type with that of the organ recipient before an operation. This system is ''redundancy.''

ADDENDA Feb. 26, 2003

3. An article in today's online issue of The Daily Tar Heel (U of North Carolina) adds further light and historical perspective to this problem. (Link not available.)

ADDENDA Feb. 28, 2003

4. A transfusion medicine physician in Cleveland has shared the following opinion (verbatim): "Here is my take on this tragedy. I do think that the process of ensuring ABO compatibility with organ donors/recipients should be at least as stringent as it is for blood donors/ transfusion recipients, given the enormously high risks if by error of one sort or another an ABO-incompatible solid organ is transplanted. Thus, in a patient who has been to multiple hospitals in or out of a system, or even to a single hospital multiple times, and we know the blood type numerous times over, it is still required,that a blood type be obtained prior to admission for another round of transfusions and that this blood type be compatible with the donor blood intended for transfusion. Even when group O blood is issued urgently prior to obtaining the blood type, typing is required retrospectively. This places accountability early on at the hospital performing the transfusion. It should be no less with organ transplantation. While one anecdotal case should not result in panic and massive onerous changes to policies and procedures, it may serve as a wake-up call to more closely scrutinize existing processes and procedures and make necessary improvements."

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