body parts

Why Can’t People With HIV Receive HIV+ Organ Transplants?

The waiting list for any organ transplant, even for an otherwise healthy young person in need, is dishearteningly long. For an HIV-positive person, the waiting list is even longer: It wasn’t so long ago poz patients were refused organs entirely, with doctors knowing their medical health was already at risk, and lawmakers refusing to let the short supply of life-saving body parts go to men and women they believed to be destined for a quick death. Except wouldn’t the problem of organ-needed poz patients be drastically reduced if they could accept organs from other HIV-positive people? Indeed. And that’s the latest push.

David Aldridge of Los Angeles had a kidney transplant in 2006, but he will soon need another. Like many people living with HIV, he suffers from kidney damage, either from the virus or from the life-saving medications that keep it at bay. Until recently, such patients did not receive transplants at all because doctors worried that their health was too compromised. Now they can get transplants, but organ-donor waiting lists are long. And for Aldridge, 45, and other HIV patients, a potential source of kidneys and livers is off limits because it is illegal to transplant organs from donors who test positive for the virus — even to others who test positive. But federal health officials and other experts are calling for repeal of the provision that bars such transplants, a 23-year-old amendment to the National Organ Transplant Act.

[…] The ban on transplanting organs from people with the virus that causes AIDS was passed at the height of the AIDS scare in 1988, when infection with the virus was considered a death sentence. But now many people with HIV are living long enough to suffer kidney and liver problems, adding to the demand for organs. This has led some health authorities to say that HIV-infected organs should be available for transplant, primarily for patients infected with the virus but also potentially for some who are not. The federal Centers for Disease Control and Prevention and other health agencies are about to issue new guidelines that will encourage a first step: research involving transplanting HIV-positive organs into HIV-positive people. But the transplant ban would have to be lifted first.

The idea that HIV-positive organs are off-limits for everyone seems … unnecessary, doesn’t it? These organs can still save lives, and if people are already carrying the virus, a positive organ is much less likely to inflict harm. Further, lifting the ban on these organs doesn’t just help poz people; it reduces the organ waiting list for everyone else.

“The clock is ticking more quickly for those who are HIV-positive,” said Dr. Dorry Segev, transplant surgery director of clinical research at Johns Hopkins and the co-author of a new study indicating that 500 to 600 HIV-infected livers and kidneys would become available each year if the law were changed. “We have a huge organ shortage. Every HIV-infected one we use is a new organ that takes one more person off the list.”

The risk in all of this, of course, is that all HIV-positive patients would be placed only on HIV+ donor lists, itself possibly a form of discrimination — since not all organs are created equal. Introducing a dead person’s HIV strain into the living person’s body could cause further health complications (which is why poz guys engaging in bareback sex with other poz guys is not the wisest decision), which researchers have yet to fully investigate. There would need to be safeguards in place to ensure that HIV-positive patients who want HIV-free organs can still have access to them. Or at least have their names added to that very long, very exasperating wait list.

[NYT]