HIV positive organ donors may help HIV negative patients too

In spite of being one of the most unproductive Congresses on record, it has managed to pass a few bills by acting in a bipartisan manner. One of these is the HOPE (HIV Organ Policy Equity) Act.

The HOPE Act, signed into law by President Obama, enables research on the transplantation of HIV positive donor organs into HIV positive recipients. It will probably lead to transplants between positive donors and positive recipients in the near future.

Before this Act, this research was forbidden under the National Organ Transplant Act written in the 1980s.

 

Researchers may now study transplants of HIV positive organs

Now, researchers can specifically study questions that are related to HIV positive to HIV positive transplants. One of these questions might be the effects of transplanting a liver from a donor with a different strain of HIV to a recipient. This research, and more, needs to be completed before HIV positive-HIV positive transplants can begin.

HIV virus attacking cell. 3D render, via Shutterstock.

HIV virus attacking cell. 3D render, via Shutterstock.

It’s estimated that there are about 110,000 people (adults and children) in the US alone who are waiting for transplants (hearts, livers, kidneys and other vital organs.) Only about 30,000 transplant surgeries are done per year, primarily because of a lack of donors. About 20 people per day die while waiting for an organ transplant. Researchers estimate that if HIV positive to HIV positive donations were allowed, about 500 lives would be saved via transplantation per year, possibly more. Many donors allow for the transplantation of any of their organs after death. So a single donor may be able to save several other people via donations of heart, liver, kidneys, lungs and other organs.

It was a struggle to make HIV positive people eligible to receive organ transplants at all

HIV positive patients can currently go on the transplant lists and receive transplants. And it was a struggle to get them on the list at all. But of course, they are getting HIV negative donor organs. Initially, when looking at transplanting HIV positive patients, several concerns were raised. Some of these were:

If the patient had AIDS, wouldn’t the AIDS kill him rapidly and therefore, he would have no benefit from the transplant? That may have been true when the National Organ Transplant Act was proposed, but now with better drugs and management, that is much less of an issue.

If the patient is immunosuppressed, wouldn’t the added post transplant immunosuppression leave him with a non-functional immune system leading to death? Research has shown that CD4 counts do decrease somewhat after immunotherapy starts post transplant, but the CD4 cell number increases after a few years on the immunosuppressives. Also, there are three different immunosuppressive drugs that can be used post-op. Changing medications may help, as does “fine tuning” the HIV positive patient just before transplant (ensuring good adherence to antiretrovirals that are appropriate for that patient, getting his viral load as low as possible, getting him in the best possible physical shape, making sure that any other diseases are well controlled, etc.)

Wouldn’t an HIV positive patient be more at risk to develop opportunistic infections, Kaposi’s sarcoma and other illnesses post transplant? Again, those may be remote possibilities. But studies on HIV positive patients who have undergone transplant and immunosuppression and ante on antiretrovirals, may show a slight increase in things like Kaposi’s of the skin. But the numbers are very low.

There have been some HIV positive to HIV positive transplants done. South Africa started doing these transplants in 2010. So there is some data available on the success rate of transplants, complications, etc. But so few of these transplants have been done, that the validity of the numbers in the results are limited by the small sample size. In one study on kidney transplant patients, the recipients did well. They maintained their viral loads at less than 50 (both before and after transplant). Their CD4 counts remained about the same over time pre-op and post-op. Their transplanted organs functioned well. They didn’t develop other HIV-related diseases post op on immunosuppressants. But again, not many transplants have been done to get reliable numbers.

Some other countries (Canada, UK) are expressing interest in looking at positive-to-positive transplantation.

There are downsides. It will take a few years to do the needed research to get the information needed to try HIV positive transplantation. Perhaps it will be shown that transplantation between people with different strains of HIV makes the recipient’s HIV more difficult to treat. There is always the possibility that an HIV positive donor organ may get transplanted into an HIV negative recipient (as happened once in Taiwan) in spite of stringent control, testing and labeling. As more data is accumulated, it may be shown that there are other side effects, not yet seen in HIV positive to HIV positive transplants.

HIV positive donors help HIV negative recipients move up the list

One other positive aspect is that non-HIV positive recipients will benefit, as well. As HIV positive donor organs become available for transplant into HIV positive recipients, the waiting list will be shortened for everyone. If 500 HIV positive donors become available per year, those 500 HIV positive recipients will get transplanted and come off the list. This will let the remaining people waiting move up the list and be closer to transplant. So, this could be some very good news for everyone on the transplant list.

Would an HIV negative patient accept an HIV positive organ if it meant saving their life?

I mentioned above the rare possibility of an HIV positive organ being transplanted into an HIV negative recipient. Now, imagine a hypothetical case. You are on a transplant list for a heart transplant and you are HIV negative. Your doctors say that you probably have less than a year to live and your only hope to stay alive is to get a heart transplant. Would you consider accepting a heart from an otherwise healthy, HIV positive compatible donor? Would you opt to wait, hoping to live long enough for a compatible HIV negative heart? What would cause you to make your particular choice?

And, may I suggest that if you aren’t already an organ donor, that you consider it. Before you think, I’m too old. I’m to sick. My religion won’t approve, or something similar, have a look at this site and read the information there. It might surprise you. And, you can begin the registration process there, too.


Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

Share This Post

  • http://www.herpeswoo.com/ HerpesWoo.com

    Great article!

  • docsterx

    My pleasure.

    For more information on transplants, donations, statistics and lots of related information you can go to http://unos.org/ UNOS is the centralized donor/transplant registry. Lots of good information, contacts, links, etc.

  • http://Imstilljosh.com/ Josh

    Thank you for following up and I checked out the links… This is huge! Thanks Again!

  • docsterx

    I’m sorry to hear that. You make a very good point about the quality of life. And, the transplant may have given her several more years, depending on the underlying condition that caused her lung problems.

  • docsterx

    Thanks.

    The 500 lives saved/year is probably a low estimate. About 500 HIV+, otherwise healthy people who could donate die/year. Each donor who donates all of his organs can save about 8 lives of those on donor lists. If they all volunteered to donate all of their solid organs and were acceptable for transplant, that would mean about 4,000 additional people could get transplanted/year. Of course, the numbers will vary based upon deaths, donor status, etc. And sometimes kidney donations aren’t considered lifesaving, since potential kidney recipients can be maintained on dialysis for years.

    News release from the journal on the contents of the article: http://www.amjtrans.com/details/news/1075675/HIV-Infected_Donors_Present_Novel_Source_of_Organs_for_HIV-infected_Transplant_C.html

    For complete details, here is a link to the journal article: http://onlinelibrary.wiley.com/doi/10.1111/j.1600-6143.2011.03506.x/full

  • Alie

    I can vouch for your last point. When my mother was dying of lung failure, we tried to argue for accepting a transplant from a patient with something like HIV. The only thing wrong was her lungs, heart and other vitals were still functioning at the level of a 30 year old. But her lungs were so fried she was in constant pain and in and out of the ER and ICU several times a month, in addition to very limited mobility the rest of the time. Seriously, just sitting up in bed to watch tv was too taxing some days. A transplant from an HIV+ donor would be a death sentence, sure, but it would allow her to live several more years without complications and a much higher quality of life until then. But the doctors said it wasn’t even an option, the law would never allow them to consider an HIV+ donor for anyone. This law was poorly thought out; I know AIDS was scaring the pants off everyone back then, but there just aren’t enough healthy donors to go around.

  • http://Imstilljosh.com/ Josh

    Good morning. Great article. Do you have a link avail about the “up to 500 lives would be saved” data you describe according to research? Thanks.

  • docsterx

    The case by case method was tried when transplants were in their infancy. But it was unworkable. When organs became available, every transplant group wanted them. Each group had the “sickest” patient. Also, with 100,000+ patients waiting for transplants, the initial evaluation of each of these cases would be hugely time consuming. Plus, as those on the lists wait, and their health deteriorates, they’d need reevaluated on a regular basis to make sure they were properly positioned as to who needed the transplant most urgently.

    Now there are algorithms in place that get used to see just how sick each patient is and, theoretically, correctly position him on the transplant list so that the most ill (closest to dying) gets the needed organ first.

    The Schiavo case became a political circus and crusade that was completely ludicrous and was only beneficial for the politicians’ self-serving ends.

  • bertinanth764

    My Uncle Jayden got a
    fantastic blue Audi S5 Convertible from only workin part-time on a home pc. the
    original source B­i­g­2­9­.­ℂ­o­m

  • nicho

    The shorter version is that these are decisions that should be taken by doctors and their ethics boards on a case by case basis.

    A case-by-case basis just opens the way for all sorts of bad things to happen. There should be clear guidelines that apply to everyone. Otherwise, a very assertive patient — or a patient with an assertive family — could receive better care than a less assertive patient would get. Some patients are more “attractive” — and I don’t mean physically attractive — and would get different care than a less “attractive” patient would get. Without clear guidelines, doctors and even their ethics boards would be left defending why they acted one way in one case and one way in another.

    This isn’t to say that the judgment of doctors should never enter the situation, but you can’t start from Square One on every case.

  • MyrddinWilt

    The shorter version is that these are decisions that should be taken by doctors and their ethics boards on a case by case basis. They should never be decided by a bunch of politicians legislating to curry favor with bigoted constituents.

    Congress didn’t do itself any credit in the Terri Schiavo affair. Some people might think it ironic that the GOP that spent so much effort to make sure Schiavo received medical treatment long after she was dead are so anxious to deny health care to the millions who are receiving it now through Obamacare and the 5 million people they have succeeded in denying coverage with the Wingnut Hole.

© 2014 AMERICAblog News. All rights reserved. · Entries RSS