An ongoing dialogue on HIV/AIDS, infectious diseases,
April 11th, 2011
Organ Transplants from HIV-Infected Donors
On the heels of last month’s report of HIV transmission from an organ donor — covered here in Journal Watch — comes this remarkable article in the New York Times about lifting the ban on organ donation from donors known to be HIV positive.
Naturally, the first group of patients slated to receive these HIV positive organs would have HIV themselves.
But the article goes further:
But some experts, including Dr. Segev and Dr. Kuehnert, say they can foresee such transplants even for H.I.V.-negative patients because contracting H.I.V. would be preferable to kidney or liver failure.
“I don’t want to minimize living with H.I.V, but it is a medically treatable disease now,” said Charlie Alexander, president of the United Network for Organ Sharing, which manages the country’s organ transplant system. “In certain cases, I think it would be medically appropriate.”
If ever there were proof that HIV is now a highly-treatable condition, I’d say this could be Exhibit One.
9 Responses to “Organ Transplants from HIV-Infected Donors”
Paul E. Sax, MD
Contributing Editor
NEJM Journal Watch
Infectious Diseases
Biography | Disclosures | Summaries
Learn more about HIV and ID Observations.
NEJM Journal Watch — Recent Infectious Disease Articles- High-Dose Oral Cephalexin for Pediatric Bone and Joint Infections
- When it Comes to Antimicrobial Stewardship, Is a Boost Better Than a Nudge?
- HIV Prevention and Treatment: Updated Recommendations from the International AIDS Society–USA
- Observations from ID and Beyond: Dr. Thomas O'Brien — Expert in Antimicrobial Resistance and Giant in His Field (Literally)
- How Serious Is Artemisinin Partial Resistance in African Malaria Parasites?
I do not agree, organ tranplantation requires immunosupression, so the recipient would be expose to a double problem.
The first HIV+ve to HIV+ve kidney transplants have already taken place in South Africa. see
http://www.nejm.org/doi/pdf/10.1056/NEJMc0900837
This will need digesting. Two immediate problems come to mind: a) do we know how reliably we can treat HIV in immune-suppressed organ recipients? and b) it might be a hard sell to the HIV-negative recipient and his/her family.
I do not agree that the ban should be lifted.
HIV can certainly be treated in an patient being immunosuppressed for organ transplantation – while it would be more complicated, and certainly more risky, it’s worth keeping in mind that presumably the UNOS president is referring to patients who 100% *will* die unless they get a transplant, and organs that presently 100% *will* be thrown away. Give me a choice between death from liver failure or heart failure, and the added risks of an HIV-positive organ, and I’ll choose the latter.
Certainly people living with HIV should be allowed to donate organs. The designated organs can be used in other people living with HIV. They also can be used in people whose choice is untimely death vs. concomitant HIV and immunosupression treatment for a donated organ which may transmit HIV. The choice should be there for the donors and recipients.
Only with informed consent documenting detailed risks vs benefit, including side effects and costs of HIV treatment.
While + to + transfers make quite a bit of sense, particularly in view of chronic organ availability, I have to disagree with the position that + to – transfers would be considered a viable alternative. Most individuals I have dealt with over the years – who are seeking organ transplant as a relief from years of chronic, debilitating illness as well as an opportunity to extend their lives – would not consider acquiring a NEW chronic, potentially debilitating disease (in addition to extended life) a reasonable trade off. Extra years without improved quality is not something most of them wish for, in my experience.
i see + to + transfers highly problematic as well, because aquiring a new hiv strain / type could be an immunologic problem for the host (even under immunosuppression!)