Allowing HIV-Positive Organ Donation: Ethical, Legal and Operational Considerati

[Clark]

http://onlinelibrary.wiley.com/doi/10.1111/ajt.12311/abstract

Allowing HIV-Positive Organ Donation: Ethical, Legal and Operational Considerations
O. Mgbako1, A. Glazier2, E. Blumberg1,3, P. P. Reese1,4,5,*
DOI: 10.1111/ajt.12311
American Journal of Transplantation
Early View (Online Version of Record published before inclusion in an issue)

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.