After months of discussion, the final review board at Tulane University Hospital voted two weeks ago to add HIV-infected individuals to the list of people eligible to receive kidney transplants.

"I think it's the right thing to do because I believe there are people out there who will benefit from it and shouldn't be excluded," said Dr. Douglas Slakey, director of abdominal transplantation at the New Orleans hospital. The surgery is less complex than other transplantations; the risk to donors is relatively low; and recovery prospects are better for all kidney recipients -- regardless of HIV status -- than for people who get other organs, Slakey said. The only HIV patients who will be ruled out are those whose condition has progressed to AIDS, because their systems are probably too frail to withstand the surgery, he said. While the hospital has not yet performed the procedure on an HIV patient, Slakey said he has about a dozen referrals.

Although the United Network of Organ Sharing has had a policy in place since 1987 saying that HIV should not keep anyone off a transplant waiting list, that policy was largely irrelevant since patient survival time was often measured in mere months. But thanks to the arrival of improved multi-drug therapy, HIV has become a manageable chronic infection for many people. To ward off the criticism that such procedures squander scarce donor organs, Slakey said he plans to rely as much as possible on kidneys from living donors.

Transplant patients must embark on lifelong drug therapy to prevent rejection of the new organ by the immune system -- an aspect of transplantation about which little information is available. But Slakey said some doctors have noticed that anti-rejection drugs also have anti-HIV properties. And because their immune systems are already suppressed, HIV patients don't require as much anti-rejection medication, doctors have found.

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