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.”
Search: transplant, organ transplant, organ donor, Congressional ban, U.S. Congress, Dorry Segev
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comments 1 - 8 (of 8 total)
Charles, , 2011-09-03 12:14:53
My Registered Domestic Partner and I live in Californina. We are in our mid-forties. He has end stage liver failure and is already on the Liver Transplant List at Cedars-Sinai in Los Angeles. Problem; He is one of those whose MELD score has gone from 20 to 27 and back to 20 but he steadily worsens. I am told there is nothig we can do but wait for a liver after he reaches at least 28 but probably more like 30-35. He may not make it there. We are both HIV+, take the same regimen of anti-retro
tbird, marion, 2011-04-28 19:45:51
damn rite they should be how the hell congress or whoever made the decision that hivers couldnt just be put on the list like anyone else is heartless and must not ever loved anyone who is positive and no it was not any bodys choice to be positive do people forget that
Larry Pyles, Fredericktown MO, 2011-04-06 21:52:22
Although I wrote earlier,that it would be a great idea, the facts of the matter is that the need for immunosupressive agents, would actually make it a contradictory possibility---unfortunately. Our (AIDS pts.) are already immunocompromised---administration of anti-rejection drugs, would only further diminish our immunity...therein lies the problem, with positive to positive or negative to positive organ transplantation..I know BUMMER! GOD BLESS ONES AND ALL!
Larry Pyles, Fredericktown MO., 2011-04-06 21:42:34
I think that the idea of allowing +donors to donate to +ppl in need is a fantastic idea, and have inquired about it countless times to my physcians. (I'm a registered nurse), and along with AIDS I suffer from polycystic kidney disease. Let's get pro-active about this ppl!!! Write your congressman!! God bless us, one and all!
theauthormike, st. petersburg, 2011-04-06 12:07:29
my t-cells are over 900 and my viral load is less than 20 so why shouldn't someone be able to take advantage of my death? I won't need them once I'm gone and it would please me to know that I was able to help another person.
robert paul, scranton, 2011-04-05 14:57:40
Phil the needs of the needy.Grateful is better than Dead- encore- your love will not fade away!Skeptical of live dead,whats unread dormant in anybodys blood-organs? Maybe you feel nobody is safe for a transplant.Your beiiefs aren't positively positive inside equality.
ilvadel, Sacramento, California, USA, 2011-04-02 10:36:56
it seems to me that since recipients often need immunosuppressive drugs to prevent organ rejection, HIV and organ donation should go hand in hand anyway
John, San Diego, 2011-04-02 02:33:04
comments 1 - 8 (of 8 total)
It would seem that this could be a winning situation for everyone involved. A positive person would not be required to take an organ from a positive donor but it could improve the chances of getting a viable donor for both negative and positive recipients.
Does anyone know if the change in the law has been proposed? Is it a national or state regulation?
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