August 2, 2002
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.
Previous research suggests that HIV infection does not likely affect how well the patient responds to the new organ. Furthermore, the researchers said therapies that suppress the immune system -- standard fare after transplantation to ensure the patient does not reject the new organ -- do not appear to increase an HIV-positive patient's susceptibility to infections. Not all patients respond equally well to transplantation, Halpern and his team wrote, and most programs offer organs to people with conditions that can affect how long they survive after receiving a new organ, such as hepatitis C and diabetes. "On ethical grounds alone, there is no justification for providing organs to these groups of patients but not to patients with HIV," they said.
07.25.02; Alison McCook