Corneas, organs or tissue donation and gay men
Apr 16, 1998
1. Should negative HIV gay men not sign an organ donor card in
accordance with FDA and CDC guidelines for organ donation? 2. How
about corneas where there are no white blood cells? 3. How about
another gay man with HIV who needs an organ or tissue? 4. For
negative HIV gay men who advocate organ donation, is there anything
appropriate in accordance with FDA and CDC guidelines that negative
HIV gay men might arrange in making their organs or tissues available?
Response from Mr. Sowadsky
Hi. Thank you for your question. Actually, this is an extremely controversial issue.
If you look at CDC and FDA guidelines, a man who has had sex with another man (since 1977) is excluded from donating blood, organs, and tissues. This is to exclude any possibility of the transmission of HIV, Hepatitis B, and other bloodborne diseases. The rates of HIV and Hepatitis B are higher among Gay men (men having sex with other men), than the overall population.
Where it starts getting controversial, is that not all Gay men are at risk for these diseases. If a Gay man has been tested for HIV and Hepatitis B, and tests negative 6 months or more after his last possible exposure to these viruses, this would then indicate that he is not infected. And if a Gay man has been vaccinated against Hepatitis B, he is not at risk for Hepatitis B. Despite this, the guidelines say that men who have had sex with other men (even one time) since 1977, are excluded from donating. It was in 1977 that HIV had most likely entered the United States.
Requirements for potential organ/tissue donors, are very similar to that of blood donors. If you look at the blood donor criteria (discussed in the posting Blood Donations), for some risk factors, if a person has ever put themselves at risk for bloodborne diseases, they may be excluded from donating (for example persons using needles for non-prescription drugs). For other risk factors, you will note that the exclusions go back 12 months (for example having sex with a prostitute, or having sex with a person known to have Hepatitis or HIV). Although screening tests for HIV and many other bloodborne diseases will most often pick up the infection by 6 months after exposure (and up to 12 months for Hepatitis C), to keep the blood supply (and the organ/tissue supply) as safe as possible, persons who have put themselves at risk for HIV and other bloodborne diseases are excluded from donation. The blood/organ screening system takes an extra-cautious approach, to keep the blood and organ/tissue supply as safe as it can possibly be. For certain risk factors, the exclusion goes back all the way to 1977 (rather than the past 12 months). This includes persons who have engaged in prostitution (having sex for drugs or money), and men having sex with other men. Why the difference between 12 months for some risk groups, and back to 1977 for others?
From a strictly clinical point of view, there really is no basis to go back all the way to 1977, only for Gay men and certain other people, when exclusions for other at-risk populations go back only 12 months. However, sometimes, public policy, and even politics, can have an effect on Public Health issues. If you do not agree with the policies as they presently stand, in the United States, you always have the ability to try to change those policies. To do this, contact your representatives from Congress, and the FDA itself.
If you have put yourself at any possible risk for HIV and other bloodborne diseases, please do not donate blood or organs/tissues. We need to keep the blood and organ/tissue supply as safe as possible. If you have not put yourself at risk for these diseases, and you are a Gay man, it is up to you whether you should try to donate or not. My position here is strictly a medical one, not a political or moral one. If you are truly not at risk of infection for these diseases, and you want to donate anyway (despite the exclusion), that is a decision that only you can make. The most important thing is that we keep the blood and organ/tissue supply as safe as possible, and that enough blood and organs/tissues are available for people who need them.
If you have any further questions, please feel free to e-mail me at "firstname.lastname@example.org" or call me at (Nationwide). I'm glad to help!
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