March 30, 2011
Ending HIV Organ Donation Ban Could Eliminate Transplant Waiting List for People With HIV
Ending a decades-old ban on using organs from HIV-positive donors could completely eliminate the current waiting list for organs among HIV-positive people needing transplants, according to a study published online March 28 in the American Journal of Transplantation.
The ban on organ donation was put in place in the 1980s around the same time as bans were put in place to prohibit people with HIV from donating blood. At that time, people with HIV were also excluded as viable candidates for receiving organ transplants. This is because most experts believed that the organs should go to people with a better chance of survival.
In the late 1990s, however—with the introduction of potent combination antiretroviral (ARV) therapy—survival for people living with HIV increased substantially, effectively ending arguments that they were less likely to live than their HIV-negative counterparts. However, the lack of available organs means that many people—both HIV positive and HIV negative—die waiting for an organ from a matched donor.
Dorry Segev, MD, PhD, and his colleagues from Johns Hopkins University in Baltimore believed that the wait for organs among people with HIV might be shortened considerably if HIV-positive people were allowed to donate their organs to other people living with the virus. In fact, given the dearth of available organs in South Africa, doctors in that country have begun transplants between HIV-positive donors and recipients there with good results.
To determine what the impact would be if the U.S. Congress were to overturn the organ donation ban and thus allow donation to other HIV-positive people, Segev’s team pulled data from two large registries of people with HIV—the Nationwide Inpatient Study and the HIV Research Network. They then estimated the number of deaths by HIV-positive people in those studies where viable organs might have been available for transplantation.
The number of such deaths was similar between the two studies, 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. This number, according to Segev and his colleagues, would be sufficient to provide donor organs to every HIV-positive person put on transplant waiting lists each year. Of course, no organs from HIV-positive people would go to HIV-negative people in need of transplants should the congressional ban be over-turned. If people with HIV don’t need organs from HIV-negative donors anymore, however, those organs would then become available to HIV-negative people on waiting lists.
“If this legal ban were lifted, we could potentially provide organ transplants to every single HIV-infected transplant candidate on the waiting list,” Segev explains. “Instead of discarding the otherwise healthy organs of HIV-infected people when they die, those organs could be available for HIV-positive candidates.”
Opening up the donor pool to HIV-positive people is not without risks. It is technically possible for an organ to be mislabeled and passed onto someone who is HIV negative. It is also possible that the strains of virus in the person donating the organ could be more virulent or drug-resistant than the strains carried by the person receiving the transplant. The authors write, however, that given the desperate need of those awaiting transplants and the number who die before a matched organ becomes available, such risks should be made on a case-by-case basis by physicians—and not limited by a law that arbitrarily forbids all donations by HIV-positive donors.
“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,” Segev concludes. “We want the decisions taken out of the hands of Congress and put into the hands of clinicians.”
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