Allowing HIV‐Positive Organ Donation: Ethical, Legal and Operational Considerations. Issue 7 (12th June 2013)

• Record Type: Journal Article
• Authors: Mgbako, O.; Glazier, A.; Blumberg, E.; Reese, P. P.
• Is Part Of: American journal of transplantation. Volume 13:Issue 7(2013)
• Page Start: 1636
• Page End: 1642
• Publication Date: 2013-06-12
• Subjects: Ethics -- HIV -- organ donation -- transplant; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.12311
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract: Case reports of kidney transplantation using HIV‐positive (HIV+) donors in South Africa and advances in the clinical care of HIV+ transplant recipients have drawn attention to the legal prohibition of transplanting organs from HIV+ donors in the United States. For HIV+ transplant candidates, who face high barriers to transplant access, this prohibition violates beneficence by placing an unjustified limitation on the organ supply. However, transplanting HIV+ organs raises nonmaleficence concerns given limited data on recipient outcomes. Informed consent and careful monitoring of outcome data should mitigate these concerns, even in the rare circumstance when an HIV+ organ is intentionally transplanted into an HIV‐negative recipient. For potential donors, the federal ban on transplanting HIV+ organs raises justice concerns. While in practice there are a number of medical criteria that preclude organ donation, only HIV+ status is singled out as a mandated exclusion to donation under the National Organ Transplant Act (NOTA). Operational objections could be addressed by adapting existing approaches used for organ donors with hepatitis. Center‐specific outcomes should be adjusted for HIV donor and recipient status. In summary, transplant professionals should advocate for eliminating the ban on HIV+ organ donation and funding studies to determine outcomes after transplantation of these organs. Abstract : In this ethical analysis, the authors contend that the legal prohibition on transplantation using HIV‐positive organs should be lifted and describe the many clinical challenges that this practice would entail.