Organs from HIV-positive donors? Ethicists also involved

This transcript has been edited for clarity.

Hello, this is Art Caplan. I am in the Department of Medical Ethics at New York University Grossman School of Medicine in New York City.

If you are a loyal listener and viewer of this podcast, you know that there is a significant shortage of organs available for transplant to people who need them. The demand for transplantable solid organs, such as livers, hearts, kidneys, and lungs, exceeds the supply of cadaveric organs in particular. Although living donors are increasingly being used in the kidney field, the supply of cadaveric organs for hearts and livers has not kept pace for many years.

Part of the reason is the fact that as transplants improve, more people are eligible for transplants, and sicker people, older people, and actually younger people – young children – are on the waiting list. This is due to For a variety of reasons, the United States is unable to donate organs at a rate that meets the demand for organs at the time of death.

what to do? There are many ideas on how to increase supply. I have had the opportunity to discuss this with funding organizations like the National Institutes of Health (NIH) who are conducting research on this topic, using organs that have a viral infection and giving them to a person who is not infected with the virus. It was to be provided. I'm worried about infection, but we may be able to deal with any problems.

In particular, this includes donating organs from people known to: HIV But we know that recipients may not get a heart or liver for a variety of reasons, and may die before the one without it appears. After some discussion, they happily say, “Yes, I would harvest organs from an HIV-positive person.”

The NIH has conducted several studies on tracking organ donations from HIV-positive people to HIV-negative people. As I said earlier, I was involved in the deliberations. There are several things you can do to minimize the risk. It's about minimizing risk, not eliminating it completely.

Recipients can be given antiretroviral therapy (ART). It has been highly successful in minimizing viral transmission among people living with HIV. If taken as prescribed, probably 95% of people will maintain nearly undetectable levels of the HIV virus in their blood, meaning they can treat any disease. HIV infection Those acquired from an HIV-positive donor. This is an incentive that makes the opportunity attractive to many people who may not be able to obtain an organ at all and who fear that they may die if they do not take this more dangerous organ.

There are also treatments such as pre-exposure prophylaxis, which gives people drugs before they become infected with HIV, and is currently used in high-risk groups, such as people who engage in risky sexual activity or who frequently receive blood transfusions. These people can take antiviral drugs before they become infected, which appear to help prevent infection.

This idea of ​​HIV could lead to a situation in which potential recipients are started on medication to increase their resistance to HIV, and then once the transplant has taken place, additional drugs are given to ensure infection is blocked. There is a gender. under.

I think this is an ethical approach. A number of steps need to be taken to ensure that people can give informed consent, where appropriate, to this increased risk. We must tell them what we know about the risk of infection. We must tell them what we know about its prevention and treatability. These are not 100% effective. Very good, but not 100%.

They need to be made aware that they may not be able to have sexual contact or exchange toothbrushes with the partners they live with or have contact with because they themselves may find out they are HIV positive. there is. It can affect their lifestyle. You will probably want to discuss this with your potential romantic partner to be aware of what exposures may be involved if a transplant from an HIV-positive donor is successful.

It's also true that we don't really know what the long-term risks are. In the short term, we know that in terms of HIV infection and its side effects on transplanted organs and other body systems, these things appear to be preventable and treatable.

To be honest, we studied HIV-positive heart transplants for 10 years to determine whether drug treatment is effective and whether HIV infection in people receiving immunosuppression has a greater rebound effect than in others. No one has ever experienced it. These are people who are simply receiving medication to treat their HIV infection.

You have to be honest and open and talk about these things. There are many people I know who are facing supply shortages and the prospect of certain death. Because we know the supply isn't there and we're at the end of the waiting list for various reasons. This is a choice. I think it should be provided. It may not be acceptable to everyone, but it could form a larger pool of donors who can help more people's lives.

I'm Art Caplan of the Department of Medical Ethics at New York University Grossman School of Medicine. Thank you for visiting.