Proposal urges use of HIV-infected organs

A proposal that would increase the number of organs available for transplant calls on doctors to consider those from deceased HIV-infected donors for use in HIV-infected patients who otherwise might die waiting for a kidney, liver or heart.

It has been illegal to transplant an HIV-infected organ into anyone since the National Organ Transplant Act was amended 23 years ago -- at the height of the HIV scare.

The proposal, reported as part of a larger study in the June issue of the American Journal of Transplantation, represents a change in how HIV is perceived, doctors said last week, and also pushes for a new way to increase the organ pool.

Dr. Ernesto Molmenti, director of the transplant program at North Shore University Hospital in Manhasset, said such a policy change is long overdue.

"The number of HIV patients who need transplants is increasing, especially for kidneys," said Molmenti, also North Shore's vice chairman for surgery.

He said kidney damage generally occurs in people infected with HIV because of the medications used to treat it. Other organs also are subject to failure in HIV patients, he said.

HIV patients have been placed on lists as transplant candidates only in recent years. Doctors previously thought the patients' viral condition so severely compromised their immunity that they could not withstand the rigors of surgery and subsequent treatments to tamp down their immune systems.

Dr. Dorry Segev, associate professor of clinical research at Johns Hopkins University in Baltimore and lead author of the report, found that 500 HIV-infected but otherwise healthy organs are discarded annually. Estimates based on Segev's research put the number of HIV-infected people in need of organs at more than 1,000.

In 2010, an estimated 178 HIV-positive people received kidneys or livers, up from nine 11 years ago, according to the HIV Medicine Association, a professional organization.

Overall, the United Network for Organ Sharing estimates more than 111,000 people await organs of all kinds, but slightly more than 2,000 donors have become available so far this year.

Because HIV/AIDS is no longer an immediate death sentence and can be managed as a chronic condition, banning HIV-infected organ transplants is no longer prudent, Segev said.

"If Congress reversed its ban," he said, "between 500 and 1,000 HIV-infected patients with kidney or liver failure each year could get transplants."

Lifting the ban could reduce HIV patients' risk of death while on the waiting list, Segev said.

Some policy experts are uncertain about the idea.

"HIV is different in every person," said Rabia Aziz, chief executive of the Long Island Minority AIDS Coalition, a policy and advocacy organization in Lindenhurst.

She questioned whether organs taken from people with highly virulent, drug-resistant strains would pose an additional threat to organ recipients.

Others fear mix-ups are possible.