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Organ Transplants

November/December 2011

Submit your questions to AAHIVM@tpan.com

Due to space limitations, not all submitted questions can be answered in this column. For more information about AAHIVM, call 202-659-0699 or visit www.aahivm.org.

Question: I received a group e-mail from a friend recently asking me to consider being an organ donor. I responded that in 1985, when I tested positive, I regrettably had to forfeit the desire to be an organ donor. My friend promptly wrote back that some medical facilities will take organs from HIV-positive patients for certain recipients. Is this so? What is the current status on organ donation for HIV-positive people?

Answer: This question presents a scenario that we might have expected to change in recent years with so many HIV/AIDS patients living longer, healthier lives.

There are currently over 112,000 people in the U.S. on the waiting list for an organ transplant and several hundred of them are HIV-positive. The Cleveland Clinic performed the first heart transplant on an HIV-positive patient in 2001 and then through 2010, the United Network of Organ Sharing recorded almost 800 HIV-positive organ recipients out of 295,345 total recipients, although the HIV status was not recorded for about 30% of this total. Currently, many transplant centers in the U.S. will perform transplants on HIV-positive patients, including the University of Pittsburgh, where one of my patients successfully underwent a liver transplant more than five years ago.

The current ban on organ donation by HIV-positive people has been in place since 1988. The web site of the Department of Health and Human Services (DHHS) specifically states, "All people, regardless of age, should consider themselves potential organ and tissue donors. There are a few absolute exclusions (HIV infection, active cancer, systemic infection) and no strict upper or lower age limits." Twenty-three years later, this law remains in effect.

Recently, four groups (American Society of Transplant Surgeons, Association for Organ Procurement, United Network for Organ Sharing, and the American Society of Transplantation) released a statement calling for a change in the 1988 law. In addition, federal health officials and physicians, including transplant surgeons, have called for repeal of the ban.

A recent paper published in the June 2011 issue of the American Journal of Transplantation by Boyarsky and colleagues at Johns Hopkins estimated that there are more than 500 HIV-positive potential donors each year in the United States. Dorry Segev, MD, a co-author of this study, stated, "The clock is ticking more quickly for those who are HIV-positive and we have a huge organ shortage. Every HIV-infected one we use is a new organ that takes one more person off the list."

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On the negative side are the risks of HIV transmission. The New York City Department of Health and Mental Hygiene reported this past March that a patient contracted HIV after receiving a kidney transplant in 2009 from a donor who was HIV-positive but not tested close enough to the time of the surgery. There were also four organ recipients in Chicago in 2007 who contracted HIV from the same deceased donor whose HIV status was erroneously noted to be negative. These cases will not help the cause of promoting organ donation by HIV-positive individuals. On the other hand, they illustrate the need to appropriately screen all potential organ donors for HIV.

One model that makes sense would be to have organs from HIV-positive donors given to transplant patients who are also positive. Indeed, such a scenario took place in 2008 in South Africa where four HIV-positive patients received kidneys from two deceased HIV-positive donors. According to the report, all four were doing well at one year after the transplant. A concern noted by some, however, would be the transmission of a more virulent strain of HIV to an organ recipient. On the other hand, the hope would be that viral replication would still be controlled by potent antiretroviral therapy. My expectation is that there will be a change in the National Organ Transplantation Act. Indeed, the CDC is expected to soon issue new guidelines that will encourage research protocols involving transplantation of organs from HIV-positive donors to HIV-positive recipients. And in 2004, the first law of its kind in the U.S. was passed in Illinois, allowing people who are HIV-positive to donate organs to others with HIV.

In a recent New York Times article, Dr. Matthew Kuehnert, director of the CDC's office of blood, organ, and tissue safety, stated, "We would like to see as many safe transplants as possible ... there is no reason why HIV-positive patients should not get transplants and that HIV-positive donors can't be used."

Jeffrey T. Kirchner, D.O., F.A.A.F.P., A.A.H.I.V.S., is with Lancaster General Hospital, Lancaster, Pa.


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This article was provided by Positively Aware. It is a part of the publication Positively Aware. Visit Positively Aware's website to find out more about the publication.
 
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