August 2, 2002
Many organ transplantation centers are hesitant to allocate donor organs to HIV-infected patients because they believe 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 many patients without HIV also need organs, which are already in short supply.
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 in the New England Journal of Medicine ("Solid-Organ Transplantation in HIV-Infected Patients," 2002;347:284-287) that no evidence exists to suggest HIV patients will experience a worsening of their conditions as a result of organ transplantation. The authors note that many HIV- infected people now live for years and are more likely to die from organs that become diseased due to causes other than HIV.
The researchers may have a lot of convincing to do. A recent survey of US directors of kidney transplantation centers revealed that 88 percent 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 in the context of a clinical trial or not.
07.25.02; Alison McCook