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Perspectives in Disease Prevention and Health Promotion Semen Banking, Organ and Tissue Transplantation, and HIV Antibody Testing

The following recommendations regarding storage and use of semen were prepared by the Food and Drug Administration and the Centers for Disease Control with the endorsement of the American Association of Tissue Banks, the American Fertility Society, and the American College of Obstetricians and Gynecologists.

The Public Health Service published its initial recommendations regarding screening prospective donors of semen, organs, or tissues for the presence of antibody to human immunodeficiency virus (HIV) in 1985 (1). The role of donated semen in the transmission of HIV infection was confirmed later that year (2). In late 1986 and early 1987, transmission of acute viral hepatitis B resulting from artificial insemination with donated semen was reported (3,4). In April of 1987, an allogenic skin graft was implicated in the transmission of HIV infection (5). A month later, a cadaveric organ donor was found positive for antibody to HIV after his organs were transplanted (6). Most recently, the House of Delegates of the American Medical Association, at its meeting held June 21-25, 1987, adopted a recommendation that testing for antibody to HIV be performed for all donors of blood, organs, or tissues intended for transplantation and for donors of semen or ova (7). Other professional organizations, such as the American Association of Tissue Banks and the American Fertility Society, have published standards and guidelines designed to prevent or minimize the possibility of transmitting disease through artificial insemination or allotransplants (8,9).

Based on current knowledge, the following recommendations are made with respect to organ and tissue transplantation and artificial insemination:

Prospective donors of organs, tissues, and semen should be tested for antibody to HIV (1,6). Tests for hospitalized donors should be run on a serum sample taken prior to the donor's receipt of any blood transfusions to avoid situations in which multiple transfusions might result in an antibody loss due to hemodilution (6). Organs and tissues from prospective donors found seropositive for HIV antibody should not be used except when the transplantation of an indispensable organ is necessary to save a patient's life.

In the past, fresh sperm has been routinely recommended for use in artificial insemination and may still be appropriate when semen is from a donor in a mutually monogamous marriage/relationship with the recipient. However, it is now considered prudent to freeze samples from all other donors and store them in that state for a minimum of 6 months. Before frozen semen is used for artificial insemination, a blood sample taken at the time the semen was collected and a second blood sample taken aminimum of 6 months later should be tested for HIV antibody. Responsible medical personnel must be certain that the blood samples are from the same donor, and the donor's identity must be assured. Frozen semen should be used only if both of the tests are negative. These special safeguards should be observed in addition to the preliminary precautions that the donor had 1) no history of risk factors for HIV infection and 2) a physical examination, properly documented by a licensed physician at the time of donation, that showed no obvious evidence of HIV infection.

The American Fertility Society has already modified its guidelines in accordance with these recommendations (10), and these revised guidelines have been accepted by the American College of Obstetricians and Gynecologists. The American Association of Tissue Banks is in the process of similarly revising its standards (personal communication).

References

  1. Centers for Disease Control. Testing donors of organs, tissues, and semen for antibody to human T-lymphotropic virus type III/lymphadenopathy-associated virus. MMWR 1985; 34:294.

  2. Stewart GJ, Tyler JPP, Cunningham AL, et al. Transmission of human T-cell lymphotropic virus type III (HTLV-III) by artificial insemination by donor. Lancet 1985;2:581-4.

  3. Mascola L, Guinan ME. Screening to reduce transmission of sexually transmitted diseases in semen used for artificial insemination. New Engl J Med 1986;314:1354-9.

  4. Berry WR, Gottesfeld RL, Alter HJ, Vierling JM. Transmission of hepatitis B virus by artificial insemination. JAMA 1987;257:1079-81.

  5. Clarke JA. HIV transmission and skin grafts (Letter). Lancet 1987;1:983.

  6. Centers for Disease Control. Human immunodeficiency virus infection transmitted from an organ donor screened for HIV antibody--North Carolina. MMWR 1987;36:306-8,314-5.

  7. American Medical Association. Prevention and control of acquired immunodeficiency syndrome: an interim report (Board of Trustees report YY). JAMA 1987;258:2097-103.

  8. American Association of Tissue Banks. Standards for tissue banking. Arlington, Virginia: American Association of Tissue Banks, 1987.

  9. American Fertility Society. New guidelines for the use of semen donor insemination: 1986. Fertil Steril 1986;46(suppl 2).

  10. American Fertility Society. Revised new guidelines for the use of semen-donor insemination. Fertil Steril 1988;49:211.



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