After being rejected by other health centers, Larry Kramer has found what he was looking for at the Thomas E. Starlz Transplantation Institute in Pittsburgh: The AIDS activist and patient has been put on a waiting list for a new liver. Dr. John Fung and the University of Pittsburgh Medical Center transplant facility have been breaking ground by performing transplants on patients with HIV/AIDS. Since 1997, the center has performed nine such transplants -more than any other center in the world.

Last month, the center put Kramer on its 1,182-patient transplant list, and he was told he could wait as little as three months or as long as a year. Kramer, who co-founded the Gay Men's Health Crisis in 1981 and the AIDS Coalition to Unleash Power (ACT UP), suffers from end-stage liver disease. Kramer said his situation is similar to that of a growing number of patients who live long enough with HIV to suffer from a second infection. Kramer said he's lucky the center is willing to accept HIV patients. Of the nation's 296 transplant facilities, Fung estimated the center is one of only a dozen willing to perform transplants on HIV patients.

The medical community has yet to debate the ethics of transplanting organs into people with HIV/AIDS. This is largely because centers like Starlz are just beginning to create possibilities, said Art Caplan, director for the Center for Bioethics at the university. "Part of the reason HIV has popped onto the radar screen is because it's become a chronic disease rather than a fatal one," said Caplan, who believes the procedure is ethical under certain criteria. Fung said he has never felt conflicted about the procedure. "We think it's justified by the major advancements they've made in HIV therapy. They're dying of organ disease before they're dying of HIV," he said.

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