HIV infected patients who need replacement organs say they should be allowed to access organs from HIV positive donors and federal health officials are considering whether its time to lift the current ban on such organ transplants.
Organ damage, and particularly kidney damage, can occur due to HIV/AIDS related infections and also due to the medications those infected with HIV are put on. This means that HIV patients often require organ donations.
Long waiting lists for organs and stigma meaning that patients with HIV may be overlooked as viable organ recipients has created a push to circumvent the waiting lists and use HIV-infected organs that would otherwise not be used for organ donations.
As The New York Times reports, this change is not being rushed into but is being carefully considered:
Until recent years, H.I.V.-positive patients were not given transplants because of concerns that the virus could destabilize transplanted organs or that the immunosuppressive drugs used in transplants might make the virus more dangerous.
But a large clinical trial found that results in H.I.V.-positive recipients are “just as good as H.I.V.-negative patients, more or less,” said the study’s leader, Dr. Peter Stock, a transplant surgeon at University of California, San Francisco. “Our kidney patients do slightly worse than the general population of transplant patients, but better than kidney transplant patients over 65.”
Last year, at least 179 H.I.V-positive people received kidneys or livers, up from 9 in 2000.
Allowing H.I.V.-positive organs to be used would create an additional supply when some 110,000 Americans are awaiting transplants. They often wait years, and sometimes are too sick when organs become available to benefit from them.
There are concerns, even among some supporters of changing the law.
“People I know in the gay community are very split on it,” said Michael Bauer, 45, of Iowa City, who became H.I.V.-positive two years ago and will probably need a liver transplant in coming years. “There’s the concept that having an H.I.V-positive donor could actually be more damaging. You could have a donor who has a tougher strain of H.I.V.”
Doctors say this and other risks could probably be managed by screening out the sickest donors and recipients.
There are concerns, however, that this may lead to an increased risk of HIV infected organs entering the general donation system and therein that previously HIV negative patients may be unknowingly given infected organs.
Advocates say that recently issued stricter guidelines on how donated organs are handled should be enough to prevent such incidents, though, as with any situation like this, the potential for mistakes is always there.
The Times reports that in South Africa a small number of HIV patients have been given organs from HIV positive donors and all but one are believed to be doing well with more transplants being scheduled, so this is not unprecedented.
Also, the U.S. currently allows Hepatitis C infected organs to be used should the recipient already be infected with Hepatitis C.