House passes bill allowing HIV+ donor organs to be transplanted into HIV+ recipients

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On November 12, the House of Representatives unanimously passed H.R. 698, the HIV Organ Policy Equity (HOPE) Act, thereby giving HIV-positive individuals in need of organ transplants better odds; the passage of the bill lifts the nationwide ban on organ donation from people who are HIV-positive, allowing such organs to be transplanted into recipients who are also HIV-positive.

The bipartisan bill, which was sponsored by Barbara Boxer (D-CA) and Tom Coburn (R-OK) in the Senate and Lois Capps (D-CA) and Andy Harris (R-MD) in the House, will now be sent to President Obama to be signed into law.

As advances in medicine have turned HIV/AIDS into a chronic health condition rather than a terminal illness, hospitals have gradually become more willing to transplant organs into patients who are HIV-positive, although some medical centers still have policies in place against it. What has not changed, however, is medical science’s views on the transplantation of an organ from a person who was HIV-positive; before the HOPE Act, such a procedure was actually illegal under federal law.

The use of organs from HIV-positive donors will remain experimental until researchers are able to learn more about the impacts of the practice. If determined to be reasonably beneficial and safe, the number of organs available for transplant into patients in need with HIV/AIDS will increase, in turn reducing time spent on the organ transplant wait list. According to organdonor.gov, someone is added to the waiting list every ten minutes—and an average of eighteen people die every day due to the shortage of donated organs. It’s undeniable that more are desperately needed.

Hospital protocol already demands all bodily fluids be treated as bio-hazards and multiple precautions taken to prevent infections being passed from patient to medical staff, or vice versa. Under the HOPE Act, if research indicates sufficiently encouraging results, the Organ Procurement Transplant Network (OPTN) will be required to develop protocols to ensure that positive-to-positive transplantation does not have a negative effect on the overall safety of the organ transplantation network.

Because transplanted organs require the recipient to take immunosuppressant drugs for the rest of their lives, having HIV/AIDS may seem almost like a moot point. However, treatment protocols currently have transplant patients taking the minimum possible immunosuppressants, with the goal of finding a balance between preventing their immune system from attacking the organ it sees as a foreign object and allowing them to fight off minor colds and infections.

In addition, the medical community had reasonable cause to be concerned that artificially immunosuppressed patients would see their HIV status progress into AIDS, thus making them even more susceptible to opportunistic infections. Fortunately, many common immunosuppression drugs also have anti-retroviral properties, and repeated studies have shown that under current drug regimens, HIV-positive transplant patients can generally expect their viral levels to remain suppressed and their T-cell counts to stay relatively steady; rates of opportunistic infection are also not considerably higher than in people with HIV who are not transplant patients.

One lingering concern that the medical community has regarding the transplanting of organs into HIV-positive patients is the drug regimen they’re already on. In addition to the potential for serious or even fatal drug interactions, some drugs are known to damage the organs such as the kidney or liver, and may have contributed to a patient’s need for a transplant to begin with, which could unquestionably lead to the new organ failing before it would be expected to. (Transplanted organs very rarely last for more than a decade.)

In addition, an organ from a patient with HIV could already have damage from the drug regimen its donor had been taking; worse, it is in fact possible to be infected with two or more strains of HIV, each of which may respond to different drugs—or may be drug-resistant.

However, medical records as well as tests can answer many questions that a transplant team might have, simply giving them more to consider regarding which, if any, of a patient’s organs should be harvested for transplant and who should be considered candidates for them. Though the odds may be against organs from HIV-positive donors lasting as long as those from the HIV-negative, a few years is better than none, and anything that increases the number of available organs for those who need them could save hundreds of lives.

429Magazine

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