JOHNS HOPKINS (US) — Legally allowing people with HIV to be organ donors after death could ensure that as many as 500 HIV-positive kidney or liver failure patients each year would only wait months—not years—for a transplant.
“If this legal ban were lifted, we could potentially provide organ transplants to every single HIV-infected transplant candidate on the waiting list,” says Dorry L. Segev, associate professor of surgery at the Johns Hopkins University.
“Instead of discarding the otherwise healthy organs of HIV-infected people when they die, those organs could be available for HIV-positive candidates.”
The ban on organ donation by HIV-positive patients was enacted in the 1980s, when AIDS was a devastating new epidemic sweeping the United States. Congress put the ban into the National Organ Transplant Act of 1984. It has never been updated, even though in most cases HIV is no longer an immediate death sentence but a chronic infection managed with medication.
Not only would HIV-positive transplant candidates get organs, but by transplanting those patients and moving them off the waiting list, the time to transplant would be shorter for non-HIV-infected patients as well.
The number of HIV-positive patients receiving kidney or liver transplants—with non-HIV-infected organs—is on the rise. In 2009, more than 100 HIV-positive patients got new kidneys and 29 got new livers. HIV-infected patients may encounter accelerated rates of liver and kidney disease due in part to the toxic effects of antiretroviral therapy, the medications that keep HIV at bay.
To estimate how many people in the U.S. who are good potential organ donors except that they are HIV-positive die each year, Segev and colleagues culled data from two main sources: the Nationwide Inpatient Study, which has information on in-hospital deaths of HIV-infected patients and the HIV Research Network, a nationally representative registry of people with HIV.
Both data sources gave approximately the same information: an average of 534 each year between 2005 and 2008 in the Nationwide Inpatient Study and an average of 494 each year between 2000 and 2008 in the HIV Research Network.
Details of the study are reported online in the American Journal of Transplantation.
Transitioning to a system where HIV-infected donor organs can be transplanted into HIV-infected patients, doctors can call on the lessons and experience of transplanting hepatitis C patients with organs from people with the same disease, Segev says.
The practice, which has not always been the standard, has substantially shortened the waiting list for recipients without significantly compromising patient or graft survival.
Segev acknowledges that using HIV-infected organs is not without concerns. Doctors need to make sure that the harvested organs are healthy enough for transplant and that there is minimal risk of infecting the recipient with a more aggressive strain of the virus. An HIV-infected organ could accidentally be transplanted into an HIV-negative recipient, but hepatitis C-infected organs are clearly marked as such and similar protocols can be developed with HIV-infected organs.
“The same processes that are in place to protect people from getting an organ with hepatitis C accidentally could be put in place for HIV-infected organs,” Segev says. “When you consider the alternative—a high risk of dying on the waiting list—then these small challenges are overshadowed by the large potential benefit.
“The whole equation for seeking a transplant for someone with HIV and kidney or liver failure would change if this source of organs became available,” he says. “We want the decisions taken out of the hands of Congress and put into the hands of clinicians.”
The research was supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases.
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