A federal ban that forbids HIV-positive donors from giving organs to HIV-positive recipients is outdated and unnecessarily restrictive and should be repealed for the benefit of all transplant patients, says a growing clutch of health care and public health experts.
HIV and transplant experts, joined by patients and other supporters at a congressional briefing in Washington at the end of June, made pleas for legislation that would remove the 1988 ban on organ donations from HIV-positive people.
Organ transplants can be lifesaving for HIV-positive patients, who because of the virus are particularly vulnerable to kidney and liver failure, doctors say. But like everyone else, these patients must wait years for an organ to become available.
If HIV-positive donors were allowed to give organs to HIV-positive patients, that would serve the dual purpose of speeding the transplant process for people with the virus and freeing a spot on the lengthy waiting lists for people who don't have HIV, said Dr. Peter Stock, a University of California, San Francisco transplant surgeon.
"Any opportunity we have to get a group of people transplanted quicker and open up spots for others makes a whole lot of sense," Stock said. "Patients with HIV are frequently getting too sick to wait for the transplant."
If the ban were repealed, he said, "they could skim five years, six years off the waiting list."
Kidneys would be taken only from deceased donors, because living donors who are HIV-positive are at risk of developing kidney disease themselves, and taking one of their two organs could present significant health problems later.
A 2011 study found that roughly 500 HIV-positive people die in the U.S. annually from non-virus-related causes, meaning their organs would be eligible for donation. Several hundred HIV-positive patients are on waiting lists for donated organs -- which means, in theory, there are enough HIV-positive potential donors for every HIV-positive patient in need.
Transplants between HIV-positive donors and recipients wouldn't necessarily be without risk. Some doctors are concerned about the possibility of passing drug-resistant strains of HIV from a donor to a recipient whose virus is under control. But Stock and other transplant experts said HIV therapy is so successful now that the likelihood of drug resistance is minimal.
That said, doctors will need to conduct clinical trials to make sure the transplants are safe. The trials could occur only after the federal ban is lifted because the current law prohibits HIV-positive donations even for research purposes. A small study in South Africa, the first to look at transplants between HIV-positive donors and recipients, found them to be safe.
The federal ban was put in place as a safety precaution during the early days of the HIV/AIDS epidemic to keep donors infected with the virus that causes AIDS from accidentally passing it to uninfected organ recipients. There wasn't any thought of giving those organs to HIV-positive patients, mostly because those patients weren't expected to live long enough to need a transplant.
But with the advent of anti-retroviral drugs that can suppress the virus and prolong by decades the lives of HIV-positive men and women, many of these patients are now suffering kidney and liver damage from HIV.
Doctors first started performing organ transplants on HIV-positive patients about 12 years ago, using donors without the virus. At the time, doctors worried that these patients would risk aggravating their HIV care by taking the hefty immunosuppressant drugs required to prevent organ rejection.
So far, that hasn't been a problem. A 2010 study led by Stock found that HIV-positive patients fared just slightly worse than average for kidney transplants, and they had better outcomes than older patients. HIV-positive patients had higher-than-average rejection rates, but the numbers weren't high enough to suggest the transplants shouldn't be done.
There has not been any obvious opposition to repealing the federal ban, and more than 100 people turned up at the June briefing, said Dr. Dorry Segev, director of clinical transplant research at Johns Hopkins University, who spoke at the event. The next step will be introducing a bill to Congress.
"At the time it was created, the ban made a lot of sense. But we've outgrown it," Segev said. "Today, that law, rather than protecting patients, is actually harming them."