Allowing People With HIV to Be Organ Donors Could Save Lives of HIV-Positive Patients With Kidney or Liver Failure

[Guest guest]

http://www.sciencedaily.com/releases/2011/03/110330101246.htm

Allowing People With HIV to Be Organ Donors Could Save Lives of HIV-Positive

Patients With Kidney or Liver Failure

ScienceDaily (Mar. 30, 2011) — If the U.S. Congress reversed its ban on allowing

people with HIV to be organ donors after their death, roughly 500 HIV-positive

patients with kidney or liver failure each year could get transplants within

months, rather than the years they currently wait on the list, new s Hopkins

research suggests.

" If this legal ban were lifted, we could potentially provide organ transplants

to every single HIV-infected transplant candidate on the waiting list, " says

Dorry L. Segev, M.D., Ph.D., an associate professor of surgery at the s

Hopkins University School of Medicine and the study's senior author. " Instead of

discarding the otherwise healthy organs of HIV-infected people when they die,

those organs could be available for HIV-positive candidates. "

Not only would HIV-positive transplant candidates get organs sooner if such

transplants were legalized, Segev says, but by transplanting those patients and

moving them off the waiting list, the time to transplant would be shorter for

non-HIV-infected patients.

The ban on organ donation by HIV-positive patients is a relic of the 1980s, when

it was still unclear what caused AIDS, at the time a devastating new epidemic

sweeping the United States. Congress put the ban into the National Organ

Transplant Act of 1984 and it has never been updated, despite the fact that HIV

is no longer an immediate death sentence but a chronic disease managed with

medication.

The number of HIV-positive patients receiving kidney or liver transplants --

with non-HIV-infected organs -- is on the rise as doctors become more

comfortable with the idea, and patients are having good outcomes, Segev says. In

2009, more than 100 HIV-positive patients got new kidneys and 29 got new livers.

HIV-infected patients may encounter accelerated rates of liver and kidney

disease due in part to the toxic effects of antiretroviral therapy, the

medications that keep HIV at bay.

Segev and his colleagues set out in their study, published early online in the

American Journal of Transplantation, to estimate the number of people who die

each year in the United States who are good potential organ donors except for

that they are HIV-positive. They culled data from two main sources -- the

Nationwide Inpatient Study, which has information on in-hospital deaths of

HIV-infected patients, and the HIV Research Network, a nationally representative

registry of people with HIV. The team determined that the number of annual

deaths with what are believed to be organs suitable for transplantation was

approximately the same as estimated by each data source -- an average of 534

each year between 2005 and 2008 in the Nationwide Inpatient Study and an average

of 494 each year between 2000 and 2008 in the HIV Research Network.

While no transplants of HIV-infected organs into HIV-infected patients have been

done in the United States because of the ban, Segev says doctors in South Africa

have started doing this type of transplant with excellent results.

Segev suggests that, in transitioning to a system where HIV-infected donor

organs can be transplanted into HIV-infected patients, doctors can call on the

lessons and experience of transplanting hepatitis C patients with organs from

people with the same disease. This practice, which has not always been the

standard, has substantially shortened the waiting list for these recipients

without significantly compromising patient or graft survival. The decision of

whether or not to use these organs is not a legal one, but one made by the

clinician.

Using HIV-infected organs is not without concerns. There are medical and safety

issues that need to be addressed. Doctors need to make sure that the harvested

organs are healthy enough for transplant and that there is minimal risk of

infecting the recipient with a more aggressive strain of the virus. There is

also a fear that an HIV-infected organ could accidentally be transplanted into

an HIV-negative recipient. Segev says that hepatitis C-infected organs are

clearly marked as such and similar protocols can be developed with HIV-infected

organs.

" The same processes that are in place to protect people from getting an organ

with hepatitis C accidentally could be put in place for HIV-infected organs, "

Segev says. " When you consider the alternative -- a high risk of dying on the

waiting list -- then these small challenges are overshadowed by the large

potential benefit. "

Segev says eliminating the prohibition on HIV-infected organ donation would have

immediate results. At first, he predicts, there would be more HIV-infected

organs than people on the waiting list. Then, as doctors realized that their

HIV-infected patients would no longer have to wait five-to-seven years for a

transplant, Segev says he thinks more and more HIV-infected patients would sign

up for the shortened list for an HIV-infected organ.

" The whole equation for seeking a transplant for someone with HIV and kidney or

liver failure would change if this source of organs became available, " he says.

" We want the decisions taken out of the hands of Congress and put into the hands

of clinicians. "

This research was supported by a grant from the National Institute of Diabetes

and Digestive and Kidney Diseases.

Other s Hopkins researchers contributing to this study include J.

Boyarsky, B.A.; C. Hall, M.D., M.P.H.; L. Singer, M.D., Ph.D.;

A. Montgomery, M.D., D.Phil.; and A. Gebo, M.D., M.P.H.

--------------------------------------------------------------------------------

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff)

from materials provided by s Hopkins Medical Institutions, via EurekAlert!,

a service of AAAS.

________________________________________________________________________________

Journal Reference:

1.B. J. Boyarsky, E. C. Hall, A. L. Singer, R. A. Montgomery, K. A. Gebo, D. L.

Segev. Estimating the Potential Pool of HIV-Infected Deceased Organ Donors in

the United States. American Journal of Transplantation, 2011; DOI:

10.1111/j.1600-6143.2011.03506.x

[Guest guest]

http://www.sciencedaily.com/releases/2011/03/110330101246.htm

Allowing People With HIV to Be Organ Donors Could Save Lives of HIV-Positive

Patients With Kidney or Liver Failure

ScienceDaily (Mar. 30, 2011) — If the U.S. Congress reversed its ban on allowing

people with HIV to be organ donors after their death, roughly 500 HIV-positive

patients with kidney or liver failure each year could get transplants within

months, rather than the years they currently wait on the list, new s Hopkins

research suggests.

" If this legal ban were lifted, we could potentially provide organ transplants

to every single HIV-infected transplant candidate on the waiting list, " says

Dorry L. Segev, M.D., Ph.D., an associate professor of surgery at the s

Hopkins University School of Medicine and the study's senior author. " Instead of

discarding the otherwise healthy organs of HIV-infected people when they die,

those organs could be available for HIV-positive candidates. "

Not only would HIV-positive transplant candidates get organs sooner if such

transplants were legalized, Segev says, but by transplanting those patients and

moving them off the waiting list, the time to transplant would be shorter for

non-HIV-infected patients.

The ban on organ donation by HIV-positive patients is a relic of the 1980s, when

it was still unclear what caused AIDS, at the time a devastating new epidemic

sweeping the United States. Congress put the ban into the National Organ

Transplant Act of 1984 and it has never been updated, despite the fact that HIV

is no longer an immediate death sentence but a chronic disease managed with

medication.

The number of HIV-positive patients receiving kidney or liver transplants --

with non-HIV-infected organs -- is on the rise as doctors become more

comfortable with the idea, and patients are having good outcomes, Segev says. In

2009, more than 100 HIV-positive patients got new kidneys and 29 got new livers.

HIV-infected patients may encounter accelerated rates of liver and kidney

disease due in part to the toxic effects of antiretroviral therapy, the

medications that keep HIV at bay.

Segev and his colleagues set out in their study, published early online in the

American Journal of Transplantation, to estimate the number of people who die

each year in the United States who are good potential organ donors except for

that they are HIV-positive. They culled data from two main sources -- the

Nationwide Inpatient Study, which has information on in-hospital deaths of

HIV-infected patients, and the HIV Research Network, a nationally representative

registry of people with HIV. The team determined that the number of annual

deaths with what are believed to be organs suitable for transplantation was

approximately the same as estimated by each data source -- an average of 534

each year between 2005 and 2008 in the Nationwide Inpatient Study and an average

of 494 each year between 2000 and 2008 in the HIV Research Network.

While no transplants of HIV-infected organs into HIV-infected patients have been

done in the United States because of the ban, Segev says doctors in South Africa

have started doing this type of transplant with excellent results.

Segev suggests that, in transitioning to a system where HIV-infected donor

organs can be transplanted into HIV-infected patients, doctors can call on the

lessons and experience of transplanting hepatitis C patients with organs from

people with the same disease. This practice, which has not always been the

standard, has substantially shortened the waiting list for these recipients

without significantly compromising patient or graft survival. The decision of

whether or not to use these organs is not a legal one, but one made by the

clinician.

Using HIV-infected organs is not without concerns. There are medical and safety

issues that need to be addressed. Doctors need to make sure that the harvested

organs are healthy enough for transplant and that there is minimal risk of

infecting the recipient with a more aggressive strain of the virus. There is

also a fear that an HIV-infected organ could accidentally be transplanted into

an HIV-negative recipient. Segev says that hepatitis C-infected organs are

clearly marked as such and similar protocols can be developed with HIV-infected

organs.

" The same processes that are in place to protect people from getting an organ

with hepatitis C accidentally could be put in place for HIV-infected organs, "

Segev says. " When you consider the alternative -- a high risk of dying on the

waiting list -- then these small challenges are overshadowed by the large

potential benefit. "

Segev says eliminating the prohibition on HIV-infected organ donation would have

immediate results. At first, he predicts, there would be more HIV-infected

organs than people on the waiting list. Then, as doctors realized that their

HIV-infected patients would no longer have to wait five-to-seven years for a

transplant, Segev says he thinks more and more HIV-infected patients would sign

up for the shortened list for an HIV-infected organ.

" The whole equation for seeking a transplant for someone with HIV and kidney or

liver failure would change if this source of organs became available, " he says.

" We want the decisions taken out of the hands of Congress and put into the hands

of clinicians. "

This research was supported by a grant from the National Institute of Diabetes

and Digestive and Kidney Diseases.

Other s Hopkins researchers contributing to this study include J.

Boyarsky, B.A.; C. Hall, M.D., M.P.H.; L. Singer, M.D., Ph.D.;

A. Montgomery, M.D., D.Phil.; and A. Gebo, M.D., M.P.H.

--------------------------------------------------------------------------------

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff)

from materials provided by s Hopkins Medical Institutions, via EurekAlert!,

a service of AAAS.

________________________________________________________________________________

Journal Reference:

1.B. J. Boyarsky, E. C. Hall, A. L. Singer, R. A. Montgomery, K. A. Gebo, D. L.

Segev. Estimating the Potential Pool of HIV-Infected Deceased Organ Donors in

the United States. American Journal of Transplantation, 2011; DOI:

10.1111/j.1600-6143.2011.03506.x