Unintended Transplantation of Three Organs from an HIV-Positive Donor: Report of the Analysis of an Adverse Event in a Regional Health Care Service in Italy

Unintended transplantation of three organs from an HIV-positive donor: report of the analysis of an adverse event in a regional health care service in Italy.
Bellandi T, Albolino S, Tartaglia R, Filipponi F. Transplant Proc. 2010;42:2187-2189.

This case study discusses errors that contributed to transplantation of infected organs and provides recommendations to improve test result communication and organizational safety culture.

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Unintended Transplantation of Three Organs from an HIV-Positive Donor: Report of the Analysis of an Adverse Event in a Regional Health Care Service in Italy