Are you pro or con taking organs from deceased donors with HIV (after their consent) and graft them to HIV(+) recipients?
The derogation for HIV(+) organ donation would allow to graft earlier the HIV(+) liver and kidney recipients and to avoid about 30% of deaths on the waiting list. The recipients may therefore have better long term survival results. This obviously will increase the pool of available grafts and free up places on the waiting list for HIV(-) candidates.
There has been a recent development in the United States where I believe that the legislation which prevented HIV +ve individuals from donating their organs has been overturned. This will allow the transplantation of HIV +ve organs into HIV +ve recipients to proceed (albeit under strict research protocols). I am hoping that someone from the US will provide more detail on this.
Hence I am all for this endeavour, particularly allowing for the era which we are in where HIV is treatable and Hepatitis C is about to be
Like you (Cristina & Deborah), I think this type of transplant is possible. The ethical issue is important. It can be solved if we demonstrate that HIV+ liver grafts produce results at least similar to HIV- liver grafts. Experimental studies are necessary.
In US, HOPE act will definitely allow the research among HIV + donor and HIV + recipients.Besides ethical dilemma as well as fear of acquiring different HIV strains from donor, it brings new hope to many more on transplant waiting list. There is still ongoing debates regarding recruitment of HIV + organ donors for HIV negative recipients. In future, it seems to be likely as we are living in era of excellent antiretroviral therapy. People are living much longer with HIV infection
Than being on dialysis.
I am the current chair of the UNOS OPO committee and one of the two national workgroup chairs for UNOS to make national recommendations on policy change to allow HIV+ organs to become available for transplant into HIV+ recipients. Our work product and recommendations are due to the UNOS board for review for approval for release to the Sec. of HHS for final consideration and subsequent national policy change by Nov. 2015. All indications are that HIV+ organ transplants will become a reality.
Correction: The due date for the Sec. of HHS to potentially make national policy changes is Nov. 21, 2017.
If the date for national policy changes to occur in the US is Nov 2017, will it be possible for transplant centers to proceed in the interim under IRB approval as long as these transplants are undertaken in a research setting? Three years seems a long time to wait.
Richard thank you for sharing this important information about the U.S. program. I agree with the astonishment of Deborah about the length of time limit. I also think that a demonstration by the different OSOs of the growing rate of HIV+ candidates' death (often young) in the WL is necessary to push the health authorities to accelerate somewhat the decision.
There has been some information provided on this topic in a session held at the World Transplant Congress in San Francisco. What is clear is that the Secretary of the HHS in the US has been charged with developing criteria for research into the area of transplantation of organs from HIV +ve donors into HIV +ve recipients. All of the institutes of the NIH will have to give their okay to these criteria before they are disseminated for further consultation. Issues of concern include HCV transmission, transmission of resistance to antivirals and transmission of recurrent disease. Hence why this process is taking so long (and why I have posted this response in order to inform the RG community who are interested in this topic).
Thank you for the information update. Certainly important for the RG comunity interested in this topic.
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