December 8, 2013
I must admit that a few years ago, when I first heard of a push being made to allow people living with HIV to be organ donors, I did not get it. Were there that many HIV-infected people in need of organs that allowing other infected people to donate theirs would make a difference? According to an article published in the American Journal of Transplantation in 2011, the answer is yes. The authors estimate that there are between 500 to 600 HIV-infected donors available each year to provide organs for infected individuals who may otherwise go without a transplant -- organs that would otherwise be thrown away. With the perpetual shortage of organs, many HIV-infected individuals would die without donated livers, kidneys and other organs. Therefore, it makes sense to allow for infected to infected donation. However, a 1988 amendment to the National Organ Donation Act of 1984 bans the use of all organs from HIV-infected donors.
That is about to change. On Nov. 21, 2013, President Obama signed the HIV Organ Policy Equality (HOPE) Act, opening the door to finding ways to safely procure and use organs from HIV-infected donors. The act calls for research and then the establishment of guidelines for donation of organs from HIV-infected people. It paves the way for a new national system that would incorporate such donations.
The need for an organ transplant is not uncommon in an aging U.S. population and people living with HIV, in particular, may require a kidney or liver transplantation given the effects of HIV, comorbid conditions, and/or treatment toxicity -- as detailed in a nice review by Valentina Stosor, M.D., from Northwestern University published in December 2013 in Clinical Infectious Diseases. The HOPE Act is practical in its recognition that many HIV-infected individuals are transplant candidates and should not be relegated to endure dialysis or die due to an obsolete law crafted in a different era. Those who advocated for this act should be applauded for their insight and perseverance.
What are some other top clinical developments of 2013? Read more of Dr. Wohl's picks.
David Alain Wohl, M.D., is an associate professor of medicine in the Division of Infectious Diseases at the University of North Carolina and site leader of the University of North Carolina AIDS Clinical Trials Unit at Chapel Hill.