If HIV-infected organs were available for HIV positive patients seeking organs for transplantation, the US national shortage and waitlist mortality rates would be reduced significantly, experts explain in the American Journal of Transplantation. However, even though HIV (human immunodeficiency virus) is not a contraindication to transplantation any more, the practice would be against federal law.

Dr. Dorry L. Segev, associate professor of surgery at the Johns Hopkins University School of Medicine, and team set out to estimate what the potential impact might be if the transplantation of HIV-infected organs were legalized for HIV-infected recipients. They gathered data to quantify the potential pool of HIV-infected deceased donors (HIVDD) from the NIS (Nationwdie Inpatient Sample).

They analyzed CDY counts, plasma HIV-1 RNA levels, and AIDS-defining illnesses and causes of death from data gathered from the HIV Research Network (HIVRN).

They identified between 481 and 652 potential HIV-infected deceased donors, of which between 39 and 90 were potential kidney-only donors, between 182 and 225 liver-only donors, and between 182 and 342 were multiorgan donors.

From the HIV Research Network they identified a yearly average of between 441 and 533 HIV-infected deceased donors.

Put simply - the authors estimate that there would probably be an extra 500 or so organ donors available if the federal ban were lifted for recipients who are HIV-positive.

There is a massive need for kidney, liver and other organ donations for transplant in the USA. However, there is one federal rule set in stone - No HIV Infections. The authors urge the authorities to exempt HIV-positive organ recipients from the "No HIV Infections" list.

Dr. Segev said:

"If this legal ban were lifted, we could potentially provide organ transplants to every single HIV-infected transplant candidate on the waiting list."

In 1984, when the AIDS epidemic was in its first years and not much was known about the disease, the National Organ Transplant Act included a ban on all organs infected with HIV.

At that time having HIV/AIDS was seen as a death sentence, today it is a chronic disease, but a treatable one. Even some very skeptic experts are today calling for studies on this subject.

Not only would HIV-positive patients waiting for an organ donation benefit, but so would other similar patients without HIV. By freeing up HIV infected organs for those who are already HIV positive, the national organ pool would be able to supply more waiting recipients who are not infected.

The United Network for Organ Sharing says that up to 20 patients each day die while waiting for a suitable organ.

HIV-infected individuals require new livers at a much higher rate than the rest of the population. A higher percentage of individuals with HIV also have hepatitis. A number of HIV patients also have high blood pressure (hypertension) and diabetes and need other organs. Other patients experience complications from antiretroviral drugs.

The authors explain that a large study on HIV-positive patients who receive organs not infected with HIV (healthy organs) is underway.

In 2004, Illinois passed a law reversing the state ban. However, it soon found that nothing could be done because of the federal (national) ban.

"Estimating the Potential Pool of HIV-Infected Deceased Organ Donors in the United States"
B. J. Boyarsky, E. C. Hall, A. L. Singer, R. A. Montgomery, K. A. Gebo, D. L. Segev
American Journal of Transplantation DOI: 10.1111/j.1600-6143.2011.03506.x



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