Cell and Tissue Banking

, Volume 13, Issue 1, pp 53–61 | Cite as

A pilot to examine the logistical and feasibility issues in testing deceased tissue donors for vCJD using tonsil as the analyte

  • Ruth M. WarwickEmail author
  • W. John Armitage
  • Akila Chandrasekar
  • Gary Mallinson
  • Stefan Poniatowski
  • Anthony Clarkson


Transplanted tissues have transmitted transmissible spongiform encephalopathies and in the UK there have been more cases of variant Creutzfeldt-Jakob disease (vCJD) than elsewhere in the world. A pilot study was undertaken to look at the feasibility of testing for vCJD in deceased donors using tonsillar tissue. This pilot showed that obtaining consent for removal and testing tonsil tissue was feasible. Donor eligibility for inclusion in the pilot was limited to tissue donors from the National Health Service Blood and Transplant, Tissue Services and to donors shared with the Corneal Transplant Service Eye Banks. Obtaining tonsillar tissue in the immediate post–mortem period was limited by the presence of rigor mortis. Tonsillar tissue was suitable for routine analysis for the presence of prion associated with vCJD in deceased tissue donors. Production and processing of tissue was straightforward and a low assay background was obtained from most samples. Since palatine and lingual tonsil tissue can be obtained in pairs it was possible, in the majority of cases, to set aside an intact sample for confirmatory testing if required. In one instance a sample was reactive by Western blot. However, the pattern of reactivity was not typical for that obtained from vCJD patients. Unfortunately the sample was not of sufficient quality for the confirmatory test to provide a conclusive result.


Deceased tissue donor vCJD Tonsil biopsy Testing Consent 


  1. Armitage WJ, Tullo AB, Ironside JW (2009) Risk of Creutzfeldt-Jacob disease transmission by ocular surgery and tissue transplantation. Eye (London) 23(10):1926–1930Google Scholar
  2. Brown P, Brandel J-P, Preese M, Sato T (2006) Iatrogenic Jacob Creutzfeldt disease; the waning of an era. Neurology 67:389–393Google Scholar
  3. Bruce ME, McConnell I, Will RG, Ironside JW (2001) Detection of variant Creutzfeldt-Jakob disease infectivity in extraneural tissues. Lancet 358:208–209Google Scholar
  4. Chohan G, Llewelyn C, Mackenzie J, Cousens S, Kennedy A, Will R, Hewitt P (2010) Variant Creutzfeldt-Jakob disease in a transfusion recipient: coincidence or cause? Transfusion 50(5):1003–1006. Epub 5 Mar 2010. PubMed PMID: 20230536Google Scholar
  5. Clewley JP, Kelly CM, Andrews N, Vogliqi K, Mallinson G, Kaisar M, Hilton DA, Ironside JW, Edwards P, McCardle LM, Ritchie DL, Dabaghian R, Ambrose HE, Gill ON (2009) Prevalence of disease related prion protein in anonymous tonsil specimens in Britain: cross sectional opportunistic survey 21 May 2009. BMJ 338:b1442. doi: 10.1136/bmj.b1442
  6. BSE Enquiry Report Crown Copyright (2000) The copyright unit, HMSO, St Clements House, 2–16 Colegate, Norwich, NR3 1BQGoogle Scholar
  7. Duffy P, Wolf J, Collins G et al (1974) Possible person-to-person transmission of Creutzfeldt-Jakob disease. N Engl J Med 290:692–693Google Scholar
  8. Editorial team Eurosurveillance (2007) Fourth case of transfusion-associated vCJD infection in the United Kingdom. Euro Surveill 12:E070118.4Google Scholar
  9. European Commission COM (2000(1))Google Scholar
  10. Health Protection Agency (2005) Report of seminar on ethical and social aspects of testing for vCJD Accessed 15th April 2009
  11. Health Protection Agency (2006) A new case of transfusion-associated variant Creutzfeldt-Jacob disease. CDR Weekly 16:2–3Google Scholar
  12. Health Protection Agency (2009) Accessed 11th Aug 2009
  13. Hill AF, Zeidler M, Ironside J, Collinge J (1997) Diagnosis of new variant Creutzfeldt-Jakob disease by tonsil biopsy. Lancet 349:99–100Google Scholar
  14. Hill AF, Butterworth RJ, Joiner S, Jackson G, Rossor MN, Thomas DJ, Frosh A, Tolley N, Bell JE, Spencer M, King A, Al-Sarraj S, Ironside JW, Lantos PL, Collinge J (1999) Investigation of variant Creutzfeldt-Jakob disease and other human prion diseases with tonsil biopsy samples. Lancet 353:183–184Google Scholar
  15. Hilton DA, Ghani AC, Conyers L, Edwards P, McCardle L, Ritchie D, Penney M, Hegazy D, Ironside JW (2004) Prevalence of lymphoreticular prion protein accumulation in UK tissue samples. J Pathol 203:733–739Google Scholar
  16. HTA (2006) Directions given under the Human Tissue Act 2004:001/2006 Annex AGoogle Scholar
  17. Lindgren PG, Hagberg H, Eriksson B, Glimelius B, Magnusson A, Sundstrom C (1985) Excision biopsy of the spleen by ultrasonic guidance. Br J Radiol 58(693):853–857Google Scholar
  18. Llewelyn CA, Hewitt PA, Knight RSG, Amar K, Cousens S, Mackenzie J, Will RG (2004) Possible transmission of variant Creutzfeldt-Jakob disease by blood transfusion. Lancet 363:417–421Google Scholar
  19. Maddox RA, Belay ED, Curns AT, Zou W-Q, Nowicki S, Lembach RG, Geschwind MD, Haman A, Shinozaki N, Nakamura Y, Borer MJ, Schonberger LB (2008) Creutzfeldt-Jacob disease in recipients of corneal transplants. Cornea 27(7):851–854Google Scholar
  20. Muracos S, Chait PG, Conolly BL, Baskin KM, Temple MJ (2001) US-guided core biopsy of the spleen in children. Radiology 218:200–206Google Scholar
  21. Peden AH, Head MW, Ritchie DE et al (2004) Autopsy detection of pre-clinical vCJD transmission following blood transfusion from a PRNP codon 129 heterozygote. Lancet 364:527–529Google Scholar
  22. Tabrizi SJ, Elliott CL, Weissman C (2003) Ethical issues in human prion diseases. Br Med Bull 66:305–316Google Scholar
  23. Tange RA, Troost D, Limburg M (1990) Progressive fatal dementia Creutzfeldt Jacob disease in a patient who received homograft tissue for tympanic membrane closure. Eur Arch Otorhinolaryngol 247:199–201Google Scholar
  24. Tullo AB, Buckley RJ, Kelly T, Head M, Bennett P, Armitage JW, Ironside JW (2006) Transplantation of ocular tissue from a donor with sporadic Creutzfeldt-Jacob disease. Clin Experiment Ophthalmol 34(7):645–649 Google Scholar
  25. Wadsworth JDF, Joiner S, Hill AF et al (2001) Tissue distribution of protease-resistant prion protein in variant Creutzfeldt-Jacob disease using a highly sensitive immunoblotting assay. Lancet 358:171–180Google Scholar
  26. MMWR Weekly (2003) Update: Creutzfeldt-Jakob disease associated with cadaveric dura mater grafts—Japan, 5 Dec 1979–2003,/52(48):1179–1181Google Scholar
  27. World Health Organisation (2003) WHO guidelines on transmissible spongiform encephalopathies in relation to biological and pharmaceutical products WHO Health Technology and Pharmaceuticals ClusterGoogle Scholar
  28. Wroe SJ, Pal S, Siddique D, Hyare H, Macfarlane R, Joiner S, Lineham JM, Brandner S, Wadsworth JD, Hewitt P, Collinge J (2006) Clinical presentation and pre-mortem diagnosis of blood transfusion-associated variant CJD. Lancet 368:2061–2067Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Ruth M. Warwick
    • 1
    Email author
  • W. John Armitage
    • 2
  • Akila Chandrasekar
    • 3
  • Gary Mallinson
    • 4
  • Stefan Poniatowski
    • 1
  • Anthony Clarkson
    • 5
  1. 1.Tissue ServicesNational Health Service Blood and Transplant (NHSBT)LondonUK
  2. 2.School of Clinical SciencesUniversity of Bristol, Bristol Eye HospitalBristolUK
  3. 3.Tissue ServicesNHS Blood and TransplantLiverpoolUK
  4. 4.NHS Blood and Transplant, International Blood Group Reference LaboratoryBristolUK
  5. 5.NHS Blood and TransplantWatford, HertsUK

Personalised recommendations