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
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.
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.
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.
Berry WR, Gottesfeld RL, Alter HJ, Vierling JM. Transmission of
hepatitis B virus by artificial insemination. JAMA
1987;257:1079-81.
Clarke JA. HIV transmission and skin grafts (Letter). Lancet
1987;1:983.
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.
American Medical Association. Prevention and control of
acquired
immunodeficiency syndrome: an interim report (Board of Trustees
report YY). JAMA 1987;258:2097-103.
American Association of Tissue Banks. Standards for tissue
banking. Arlington, Virginia: American Association of Tissue
Banks, 1987.
American Fertility Society. New guidelines for the use of semen
donor insemination: 1986. Fertil Steril 1986;46(suppl 2).
American Fertility Society. Revised new guidelines for the use
of
semen-donor insemination. Fertil Steril 1988;49:211.
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