ORGAN TRANSPLANTS: Should HIV Patients Be Eligible?

      The growing incidence of HIV-positive people going several years without developing AIDS has presented doctors with an ethical dilemma about whether these patients should be eligible for organ transplants, the Arizona Daily Star reports. Four major transplant centers -- the University of Pittsburgh, the University of California-San Francisco, Mt. Sinai Medical Center in New York and the University of Pennsylvania -- have initiated the "tricky and controversial experiment" of conducting transplants on HIV patients. Previously, hospitals rejected these patients because of their short life expectancy, but the increased effectiveness of multi-drug combination antiretroviral therapy has transformed HIV into a "chronic disease," the Star reports. Dr. John Fung, director of the liver transplant program at the University of Pittsburgh, said that five of the six HIV-positive patients who received new livers in the past two years have so far survived. "This limited experience suggests that organ transplantation is effective in selected HIV-positive patients" -- those "whose virus has been beaten back to undetectable levels" -- he wrote in a recent report. Fung cites former basketball star Earvin "Magic" Johnson as a good example. Liver transplants make up the majority of transplants performed on HIV-positive patients, because many of these patients suffer from hepatitis C, a disease that attacks the liver and is contracted through the same avenues as HIV -- unprotected sex, tainted blood and intravenous drug use.

Medical Concerns
      Despite this apparent early success, many physicians share Medical Director of the American Liver Foundation Dr. Adrian Di Bisceglie's belief that "adding HIV patients to the transplant list will further strain a very limited resource" of available organs. Dr. Jack Copeland, heart transplant chief at the University of Arizona, stated that his concerns center not on the behavioral aspects of the disease, but on the medical question of whether the immune system suppressant drugs necessary to prevent rejection of the new organ might pose a risk to HIV patients. He said, "It's a pretty bizarre thing to immuno-suppress the immuno-suppressed ... You could open a Pandora's box of infections and lymphomas. It's a new idea to me, a very tough question." The university's head of transplantation services, Connie Glasby, added that the hospital would wait to see the results produced in the large transplantation centers, but stressed that it would not rule out HIV patients based on ethical or behavioral reasons. Glasby said, "We don't want to make the life and death decision -- do they deserve it? We don't want to be in the position of playing God with people who need organ transplants." Glasby likened this situation to the hospital's decision to grant liver transplants to alcoholics, but only those who have quit drinking. This process, like the potential one that would screen HIV patients, ensures that "donor organs are given to good candidates," she said (McClain, 8/22).