Transplants For HIV+ Patients? Ethicists Say Yes

By Alison McCook

NEW YORK (Reuters Health) - Patients who are HIV positive and need an organ transplant should receive equal access to donor organs, according to some US doctors and ethics experts.

Many transplantation centers are hesitant to allocate donor organs to HIV-infected patients because they believe that immune system-suppressing drugs--which must be taken by transplant patients for the rest of their lives--may further damage an HIV patient's already embattled immune system. Such centers also note that organs, which are in short supply, are also needed by many patients without HIV.

However, Scott D. Halpern and Dr. Arthur Caplan, of the University of Pennsylvania School of Medicine in Philadelphia, and colleague Dr. Peter Ubel, of the Veterans Affairs Ann Arbor Healthcare System in Michigan, argue that no evidence exists to suggest HIV patients will experience a worsening of their conditions as a result of organ transplantation.

Furthermore, the authors note that many people infected with HIV now live for years, and are more likely to die from organs that become diseased due to other causes other than HIV.

"Transplant physicians often have to make tough calls about how patients with chronic illnesses might benefit from a new organ," Halpern told Reuters Health. "We hope our article stimulates both physicians and the public to think about HIV just like other conditions, such as diabetes and heart disease, that must be weighed in making these difficult decisions."

The researchers may have a lot of convincing to do. A recent survey of directors of kidney transplantation centers across the US revealed that 88% would not transplant an organ in an otherwise healthy HIV-positive patient. Furthermore, only a fraction of transplantation centers have agreed to participate in a study investigating how HIV-positive patients respond to organ transplantation.

However, Halpern and his team recommend that doctors permit HIV-positive patients to receive organs, whether or not it's in the context of a clinical trial. Previous research suggests that HIV infection does not likely affect how well the patient responds to the new organ. Furthermore, they note therapies that suppress the immune system--standard fare after transplantation to ensure the patient does not reject the new organ--do not appear to increase an HIV-positive patient's susceptibilityto infections.

Not all patients respond equally well to transplantation, Halpern and his team write, and most programs offer organs to people with conditions that can affect how long they survive after receiving a new organ, such as hepatitis C and diabetes.

"On ethical grounds alone, there is no justification for providing organs to these groups of patients but not to patients infected with HIV," the authors write in the July 25th issue of the New England Journal of Medicine web sites

"Transplant specialists have a long history of expanding transplantation to patients who they previously thought were too 'risky' to transplant, such as people with alcoholic liver disease," Ubel told Reuters Health. "We felt the time was right to do the same for HIV patients."

"I think this ball was already starting to roll. We are just giving it a push," he added.

And what would he say to some one who is not infected with HIV, who also needs a new organ?

"You deserve an organ just as much, but no more, than any other patient whose life depends on a transplant, " he said. "Survival is not guaranteed for everyone, so organs should be distributed fairly among those in need who are likely to benefit."

SOURCE: New England Journal of Medicine 2002;347:284-287.

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This article posted September 14, 2002.