- Category: Liver & Kidney Disease
- Published on Tuesday, 03 July 2012 00:00
- Written by Liz Highleyman
Legislators should lift a federal ban that prevents people with HIV from receiving organs donated by other HIV positive people, experts urged at a Congressional briefing on June 27, 2012.
The briefing -- jointly sponsored by the HIV Medicine Association (HIVMA), amfAR, the Human Rights Campaign, AIDS United, and the Treatment Action Group, along with Senators Barbara Boxer and Tom Coburn, MD, and Rep. Lois Capps, RN -- featured testimony from transplant surgeons, a representative of the United Network for Organ Sharing, and a kidney transplant recipient.
The National Organ Transplant Act, implemented in the mid-1980s, was intended to protect patients and providers against HIV transmission, at a time when HIV positive people were considered too ill to be eligible for transplants. With the advent of effective antiretroviral therapy, however, people with HIV are often healthy enough to undergo transplantation, and many need them due to HIV-related kidney disease or liver disease caused by hepatitis B or C coinfection.
Donated organs for transplantation are in short supply, and many people die while on waiting lists. According to HIVMA, there are more than 100,000 patients on active waiting lists, but fewer than 30,000 transplants performed each year. Allowing people with HIV patients to receive organs from donors of the same status could both open up a new supply of organs for HIV positive people and free up organs for HIV negative recipients.
Studies have shown that people with HIV can do well after transplantation, with short- and medium-term survival rates approaching those of HIV negative patients. Concerns that immunosuppressant drugs used to prevent organ rejection would worsen HIV disease have not been confirmed. Further study is needed on transplants between HIV positive donors and recipients, but even research is prohibited under the current U.S. ban. A team in South Africa, however, has reported good outcomes with positive-to-positive kidney transplants.
HIVMA estimates that lifting the "outdated" ban could save the lives of more than 1000 HIV positive individuals per year. There are several hundred people with HIV on organ waiting lists in the U.S., and approximately 500 HIV positive people die each year from causes that would leave them eligible to donate organs. Additional transplants could also potentially save $500,000 per patient compared with letting them get sicker.
Opponents of the ban fear that HIV-infected organs could possibly transmit other pathogens that cause opportunistic infections, that HIV positive people could become super-infected with more aggressive or drug-resistant strains, or that HIV negative people could potentially receive an infected organ by mistake. But HIVMA points to the success of systems in place to manage transplants between donors and recipients with hepatitis C virus. To date, there have been no cases of an organ from a donor with hepatitis C accidentally allocated to an uninfected patient.
"Any opportunity we have to get a group of people transplanted quicker and open up spots for others makes a whole lot of sense," said University of California San Francisco transplant surgeon Peter Stock, a pioneered in performing transplants for people with HIV.
HIV Medicine Association. Congressional briefing announcement. June 25, 2012.
HIV Medicine Association. Frequently Asked Questions: Transplantation of organs from HIV-infected donors to HIV-infected recipients.
E Allday. Plea to End Transplant Ban Between HIV Patients. San Francisco Chronicle. July 2, 2012.
R Dottinga. Transplant Surgeons Lobby to End Organ Donation Ban Between HIV-Positive People. HealthDay. June 28, 2012.