* the owner of the lab that realized the tests (PCS Lab Saleme) is the cousin of the former secretary of health from Rio, Dr.Luizinho.
* Anvisa (brazil health regulatory agency) alleges the lab didn't have the kits to realize the blood exams and didn't present the receipts proving their purchases, leading to the suspicion
they didn't do the tests at all and forged the results.
* Since many hospitals outsourced donor organ tests to the 3rd party lab, there is a precedent for more cases of infected organs, so the stored material of 286 donors will be retested by HemoRio, a state health unity.
No. That is just naive pattern-matching against a hot-button issue that you read a lot about on HN. For both this story AND Boeing, the explanation is more complicated than “outsourcing bad!”
In this particular case you're saying you need to test the organs once at the outsource place and then again at the hospital? Why not just get rid of outsourcing then?
No, that is not what the parent said. "Check an verfiy" can come in diffrent forms and tastes eg. having some samples (not all) checked by another lab, asking for standards and inspection performed by 3rd parties, asking and checking for documentation...the hell how do you think anybody could work with suppliers?
> eg. having some samples (not all) checked by another lab,
I don't think that is useful at all in case of rare diseases. You would just get two reports saying that the random sample is free of HIV.
Much better would be to send some known control samples. Making sure that some of the samples is known HIV+, and then check if the supplier can tell which ones are those.
If your reaction is that Apple’s core competency is in marketing and design and not manufacturing then i will ask if the same pattern couldn’t be applied to Boeing.
Further context: In Brazil since we have universal health care provided by the government, generally speaking non outsourced or contractors becomes public servants.
The issue is: Public service in Brazil is expensive and is virtually impossible to fire anyone. On top of that the cost of public service has second order effects in the public balance sheet for the municipalities plus it has a huge burden in the public retirement system.
Not saying that is right or wrong, but this is very common in the Brazilian heath system.
You don’t check the organs. You check the process by intermingling known HIV+ samples and check if they are being detected.
> Checking means re-testing, so might as well get rid of outsourcing.
Thing is you need to do QA on the testing system no matter what. Doesn’t matter if it is performed by contractors, in house staff or little grey aliens. If you are not doing QA you won’t know if the testing is done correctly or not.
Nothing wrong with outsourcing as long as it doesn't allow the user of the third-party operation to escape legal liability for failures and fraud committed by said third party that affect the user's clients.
What happens if someone contracts HIV and dies over the next 2 weeks before the virus is detectable in tests. Would it propagate even in a dead body? Using an organ from this donor would cause HIV either ways and so is honestly a risk factor for US donors as well.
Organ transplants are "ooh, shiny" headline grabbing medicine. Better healthcare to try to keep your original equipment is boring and gets dismissed as "just lucky." It's hard to prove a connection between x, y z and not needing a transplant.
Any criticism or critique of this paradigm gets hated on without anyone really listening or wondering what might motivate someone to be not crazy about our "we are borg" trends in medical care.
Why? If you have HIV you need to be on antiretroviral drugs. They keep your viral load to undetectable levels, so your immune system does not need to fight it.
Yep, if HIV progresses to the point of AIDS, suppressing your already-suppressed immune system would be bad. But with today's treatment regimens HIV won't progress anywhere near that point. Which is borderline miraculous, really.
HIV is the virus that makes you develop (or "acquire") AIDS; AIDS is the condition that weakens and kills you. If you pump the breaks as soon as possible, HIV on its own won't have catastrophic health implications, although it's obviously better not to have it at all.
Not true at all! You can absolutely get pregnant with HIV, and there are a number of steps you can take to prevent transmission to an unborn child.
Similarly, if you take antivirals to get your viral load down to undetectable levels, the risk of sexual transmission is very, very low. The risk is even lower if your partner takes PrEP as well.
You certainly need to take precautions, but people with HIV can live full, normal lives.
Rio de Janeiro is by far the most corrupt Brazilian state. Its hard to explain how bad it is if you are not Brazilian, but imagine that every single former state governor and many of the mayors have been sent to prison for corruption after their term ended.
So what usually happens is that someone from the public sector opens up a public bidding for some service to be done by the private sector, and usually who wins is someone who has ties with the local government.
Most of the time whoever wins the bid (usually some shell company) is going to barely offer the service, and share most of the profits with their associates in the local gov.
This is one of such cases: The private lab doing the tests is owned by the cousin of the former state secretary of health Dr.Luizinho. Its very likely that they just did not do the tests at all (yes, that how bad it is)
I usually direct people to watch the movies Elite Squad 1 and 2. They're entertaining and pretty much explain why Rio is so violent and so corrupt and how both things feed off each other.
Interesting perspective on the impact of corruption across different countries. It's striking how two countries with similar levels of corruption can have vastly different outcomes in specific areas. Take Argentina as an example: while it's highly corrupt, organ transplants are remarkably well-organized under a single entity, INCUCAI [1]. You can even see crystal clear stats there.
Corruption is not a single axis, for example college entrance exams and voting in brazil are very trustworthy in my opinion.
Institutions are corrupt, not a whole country. Sure there is some level of infection between institutions but there is still a lot of a single one can do.
Similarly to the Mongolian government, except that only major cases are targeted, and instead of the actual culprits, people who were just doing their jobs under them end up in prison. Case closed.
How free do people feel to speak up against corruption? Like could they go public on Twitter/X and call out the issues they see? Or would they face legal retribution or physical violence?
It really depends. Locally, factions like criminal associations and retired cops mafias (militias), who always have city councelors and mayors in their pockets, may retaliate if someone with an audience is being too annoying (see Marielle Franco's case).
Nationally, not all politicians enjoy any protection from the supreme court against critiscism, only the best connected ones and the supreme court itself. Recently, a former YouTuber who lost all his social accounts and had to self-exile to the US for some disrespectful comments against the supreme court was sentenced to 1.5 years in jail for calling the newest supreme court judge a "fatty".
Except for the supreme court itself, the average Brazilian can voice their concerns and speak up against corruption with very low chances of repercussions if they don't display wholly anti-democratic discourse, like wishing the military to execute a coup.
Freedom of expression is guaranteed in Brazil. In general people feel free to speak and that hasn't changed.
What has become a crime is the spread of misinformation in the form of fake news. For the most part these are still legislated fairly IMHO. But the precedent feels a bit dangerous
AIDS is the immune deficiency-causing virus, and that begins (usually) way after an HIV infection takes place — months, years. So until then, they’d still need to take immunosuppressants.
to be clear, I believe modern antiretrovirals can prevent the virus from replicating for an entire lifetime. They bring the viral load down to undetectable levels.
Isn't the window period large enough for the HIV test that it could slip through that way, i.e. you get infected on Friday, die and organs get harvested/get tested on Monday (or possibly longer) but you have not been infected long enough for the test to detect it? I had to sign a waiver acknowledging this possibility when I had some dental procedure last year.
Yes, incredible. When HIV/AIDS emerged, dentists were among the first professionals to adopt protective measures.
I don't have more details than what's mentioned in the article, but situations like this can sometimes reflect a deeper issue within the underlying professional and organizational structures, almost as if they're "calcifying", not just negligence, but a symptom of how things are functioning beneath the surface. On the other hand, it might simply be a case of individual malpractice, though I think the latter will be rare in the context of transplants.
It is but the test isn’t fully considered accurate for the first 30 days (45-90 days to be conclusive). That’s a long window of time for the virus to spread.
For those who watch medical shows, this is somewhat reminiscent of a case of several patients who contracted rabies through organ transplants - a story that was portrayed in Scrubs season 5 episode 20, "My Lunch".
> laboratory responsible for conducting tests on donated organs had been suspended after the organs from two donors were transplanted into six people
So they missed the same thing twice, presumably at around the same time.
> and all stored organs from donors are being tested back to December 2023 when the lab was hired
I had the impression that there was a very short time limit, like maybe as long as a couple days. Is this just wrong, or does it only apply to same things?
Just for additional note:
* the owner of the lab that realized the tests (PCS Lab Saleme) is the cousin of the former secretary of health from Rio, Dr.Luizinho.
* Anvisa (brazil health regulatory agency) alleges the lab didn't have the kits to realize the blood exams and didn't present the receipts proving their purchases, leading to the suspicion they didn't do the tests at all and forged the results.
* Since many hospitals outsourced donor organ tests to the 3rd party lab, there is a precedent for more cases of infected organs, so the stored material of 286 donors will be retested by HemoRio, a state health unity.
> Dr.Luizinho.
He was also short listed to take over the Ministry of Health under Bolsonaro’s government.
> Since many hospitals outsourced donor organ tests to the 3rd party lab
It's the same sort of rampant outsourcing that doomed Boeing. This time instead of screwing passengers it screwed patients.
No. That is just naive pattern-matching against a hot-button issue that you read a lot about on HN. For both this story AND Boeing, the explanation is more complicated than “outsourcing bad!”
Yeah, it's more about the failure of the checks and balances in both cases. Old school corruption really.
Okay — what makes it more complicated?
Because you can have solid outsourced work, as long as you bother to check and verify that work.
In this particular case you're saying you need to test the organs once at the outsource place and then again at the hospital? Why not just get rid of outsourcing then?
No, that is not what the parent said. "Check an verfiy" can come in diffrent forms and tastes eg. having some samples (not all) checked by another lab, asking for standards and inspection performed by 3rd parties, asking and checking for documentation...the hell how do you think anybody could work with suppliers?
> eg. having some samples (not all) checked by another lab,
I don't think that is useful at all in case of rare diseases. You would just get two reports saying that the random sample is free of HIV.
Much better would be to send some known control samples. Making sure that some of the samples is known HIV+, and then check if the supplier can tell which ones are those.
> Why not just get rid of outsourcing then?
The problem is corruption. I don't see why you think that wouldn't plague internal operations.
I haven’t seen a company outsource a core competency and succeed, eg Boeing outsourcing airplane manufacturing.
How about Apple and Foxconn?
If your reaction is that Apple’s core competency is in marketing and design and not manufacturing then i will ask if the same pattern couldn’t be applied to Boeing.
Further context: In Brazil since we have universal health care provided by the government, generally speaking non outsourced or contractors becomes public servants.
The issue is: Public service in Brazil is expensive and is virtually impossible to fire anyone. On top of that the cost of public service has second order effects in the public balance sheet for the municipalities plus it has a huge burden in the public retirement system.
Not saying that is right or wrong, but this is very common in the Brazilian heath system.
Outsourcing isn't a problem, people don't make their own clothes. It's inadequate checks relative to the risk of the component.
How are you gonna check the organs? You can't see HIV on the organs by eye. Checking means re-testing, so might as well get rid of outsourcing.
> How are you gonna check the organs?
You don’t check the organs. You check the process by intermingling known HIV+ samples and check if they are being detected.
> Checking means re-testing, so might as well get rid of outsourcing.
Thing is you need to do QA on the testing system no matter what. Doesn’t matter if it is performed by contractors, in house staff or little grey aliens. If you are not doing QA you won’t know if the testing is done correctly or not.
Nothing wrong with outsourcing as long as it doesn't allow the user of the third-party operation to escape legal liability for failures and fraud committed by said third party that affect the user's clients.
What happens if someone contracts HIV and dies over the next 2 weeks before the virus is detectable in tests. Would it propagate even in a dead body? Using an organ from this donor would cause HIV either ways and so is honestly a risk factor for US donors as well.
Organ transplants are "ooh, shiny" headline grabbing medicine. Better healthcare to try to keep your original equipment is boring and gets dismissed as "just lucky." It's hard to prove a connection between x, y z and not needing a transplant.
Any criticism or critique of this paradigm gets hated on without anyone really listening or wondering what might motivate someone to be not crazy about our "we are borg" trends in medical care.
Shades of the UK infected blood scandal of the 1970s -- 1990s:
<https://en.wikipedia.org/wiki/Infected_blood_scandal_in_the_...>
the same thing happened in the states and France among other countries, it was a global thing
At the bottom of the Wikipedia article I'd linked are references to similar scandals in France as you note, Arkansas, Libya, Italy, and Scotland.
That’s rough cause transplants usually mean immunosuppressants which is precisely what you don’t want for hiv
Why? If you have HIV you need to be on antiretroviral drugs. They keep your viral load to undetectable levels, so your immune system does not need to fight it.
Yep, if HIV progresses to the point of AIDS, suppressing your already-suppressed immune system would be bad. But with today's treatment regimens HIV won't progress anywhere near that point. Which is borderline miraculous, really.
HIV is the virus that makes you develop (or "acquire") AIDS; AIDS is the condition that weakens and kills you. If you pump the breaks as soon as possible, HIV on its own won't have catastrophic health implications, although it's obviously better not to have it at all.
> HIV on its own won't have catastrophic health implications
Yes it does.
You can never let your blood or sexual fluids come in contact with another uninfected person and you can also never be a mother.
Your lifespan probably won't be impacted all that much.
These are two wildly different things.
Not true at all! You can absolutely get pregnant with HIV, and there are a number of steps you can take to prevent transmission to an unborn child.
Similarly, if you take antivirals to get your viral load down to undetectable levels, the risk of sexual transmission is very, very low. The risk is even lower if your partner takes PrEP as well.
You certainly need to take precautions, but people with HIV can live full, normal lives.
Normal lives is not exactly the correct term. Like any drugs, HIV medication come with their own bagage of side effects.
Let's say people with HIV can live like most people receiving treatment for a chronic disease.
The rest of your points stands.
A little bit more context:
Rio de Janeiro is by far the most corrupt Brazilian state. Its hard to explain how bad it is if you are not Brazilian, but imagine that every single former state governor and many of the mayors have been sent to prison for corruption after their term ended.
So what usually happens is that someone from the public sector opens up a public bidding for some service to be done by the private sector, and usually who wins is someone who has ties with the local government.
Most of the time whoever wins the bid (usually some shell company) is going to barely offer the service, and share most of the profits with their associates in the local gov.
This is one of such cases: The private lab doing the tests is owned by the cousin of the former state secretary of health Dr.Luizinho. Its very likely that they just did not do the tests at all (yes, that how bad it is)
Just another normal day in Rio de Janeiro.
Rio de Janeiro is corrupt, but it is far from the most corrupt in relative terms. Contrary to popular perception is not even one of the most violent.
> Its hard to explain how bad it is if you are not Brazilian
It's hard to explain to most Brazilians too.
People go there expecting the worst. I don't think I've met anyone that wasn't still surprised.
Huh, as a South African, now I'm quite intrigued to visit it.
I usually direct people to watch the movies Elite Squad 1 and 2. They're entertaining and pretty much explain why Rio is so violent and so corrupt and how both things feed off each other.
Interesting perspective on the impact of corruption across different countries. It's striking how two countries with similar levels of corruption can have vastly different outcomes in specific areas. Take Argentina as an example: while it's highly corrupt, organ transplants are remarkably well-organized under a single entity, INCUCAI [1]. You can even see crystal clear stats there.
[1] https://www.argentina.gob.ar/salud/incucai
Corruption is not a single axis, for example college entrance exams and voting in brazil are very trustworthy in my opinion.
Institutions are corrupt, not a whole country. Sure there is some level of infection between institutions but there is still a lot of a single one can do.
> voting in brazil are very trustworthy
How can a closed system that cannot be audited be considered trustworthy? After the voting happens, there's no physical proof of the vote.
Highly recommend reading this: https://dfaranha.github.io/project/evoting/
One thing you don't see in Brazil is traffic police or bureaucrats asking for petty bribes, something which is quite common in neighbouring countries.
Corruption is a problem for sure, but I think incompetence and lack of initiative are far worse issues in the Brazilian executive.
> but imagine that every single former state governor and many of the mayors have been sent to prison for corruption after their term ended
Sounds similar to Illinois
Similarly to the Mongolian government, except that only major cases are targeted, and instead of the actual culprits, people who were just doing their jobs under them end up in prison. Case closed.
How free do people feel to speak up against corruption? Like could they go public on Twitter/X and call out the issues they see? Or would they face legal retribution or physical violence?
It really depends. Locally, factions like criminal associations and retired cops mafias (militias), who always have city councelors and mayors in their pockets, may retaliate if someone with an audience is being too annoying (see Marielle Franco's case).
Nationally, not all politicians enjoy any protection from the supreme court against critiscism, only the best connected ones and the supreme court itself. Recently, a former YouTuber who lost all his social accounts and had to self-exile to the US for some disrespectful comments against the supreme court was sentenced to 1.5 years in jail for calling the newest supreme court judge a "fatty".
Except for the supreme court itself, the average Brazilian can voice their concerns and speak up against corruption with very low chances of repercussions if they don't display wholly anti-democratic discourse, like wishing the military to execute a coup.
Freedom of expression is guaranteed in Brazil. In general people feel free to speak and that hasn't changed.
What has become a crime is the spread of misinformation in the form of fake news. For the most part these are still legislated fairly IMHO. But the precedent feels a bit dangerous
See the recent spat between the Brazilian supreme court and Twitter for your answer there
So dumb question, but if you have HIV, does that mean you won't have transplant rejection? Or are there two different mechanisms of immunity here?
(Disclaimer: not a doctor)
AIDS is the immune deficiency-causing virus, and that begins (usually) way after an HIV infection takes place — months, years. So until then, they’d still need to take immunosuppressants.
> AIDS is the immune deficiency-causing virus
AIDS (Acquired Immune Deficiency Syndrome) the illness, whereas a HIV infection (Human Immunodeficiency Virus) is its cause.
That's what I meant but I accidentally used the term virus, thanks.
to be clear, I believe modern antiretrovirals can prevent the virus from replicating for an entire lifetime. They bring the viral load down to undetectable levels.
Oh of course, I just meant to emphasize that it isn't HIV that causes immune system deficiency, therefore, transplant rejection can still occur.
They're miracle drugs, but they aren't panaceas.
Hopefully they are administered before too much damage to the immune system is done.
And hopefully the treatment regimen is adhered to, because the virus can become resistant.
It is so much better to not have the virus in the first place.
Maybe people with HIV just shouldn't donate blood or organs...
It's possible they didn't know they were infected.
Its just bizarre to me how simple this is to avoid.
Its one of the most common place tests in the world.
Isn't the window period large enough for the HIV test that it could slip through that way, i.e. you get infected on Friday, die and organs get harvested/get tested on Monday (or possibly longer) but you have not been infected long enough for the test to detect it? I had to sign a waiver acknowledging this possibility when I had some dental procedure last year.
Sounds reasonable, but why would they have you sign that before having a dental procedure?
Is it in case one of the doctors or nurses infects you?
Cadaver allografts (for dental bone implants) can transfer HIV.
Yes, incredible. When HIV/AIDS emerged, dentists were among the first professionals to adopt protective measures.
I don't have more details than what's mentioned in the article, but situations like this can sometimes reflect a deeper issue within the underlying professional and organizational structures, almost as if they're "calcifying", not just negligence, but a symptom of how things are functioning beneath the surface. On the other hand, it might simply be a case of individual malpractice, though I think the latter will be rare in the context of transplants.
Rio isn't exactly known for its solid institutions or sanitary excellence.
It is but the test isn’t fully considered accurate for the first 30 days (45-90 days to be conclusive). That’s a long window of time for the virus to spread.
For those who watch medical shows, this is somewhat reminiscent of a case of several patients who contracted rabies through organ transplants - a story that was portrayed in Scrubs season 5 episode 20, "My Lunch".
> laboratory responsible for conducting tests on donated organs had been suspended after the organs from two donors were transplanted into six people
So they missed the same thing twice, presumably at around the same time.
> and all stored organs from donors are being tested back to December 2023 when the lab was hired
I had the impression that there was a very short time limit, like maybe as long as a couple days. Is this just wrong, or does it only apply to same things?