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

https://doi.org/10.1111/ajt.12311Get rights and content
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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.

Key words:

Ethics
HIV
organ donation
transplant

Abbreviations

ESRD
end-stage renal disease
HCV
hepatitis C virus
HIVRN
HIV Research Network
IRB
Institutional Review Board
KTR
kidney transplant recipient
NIS
Nationwide Inpatient Sample
NOTA
National Organ Transplant Act
OPO
organ procurement organizations
OPTN
Organ Procurement and Transplantation Network
UNOS
United Network of Organ Sharing.

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