AIDS/HIV+ infected Organs for Transplantation — Pros and Cons

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A few weeks ago, an LA Times article about HIV+ infected organs came out which intrigued me, the reason being that typically “HIV” and “Organ Donation” together in the same sentence usually elicits a negative connotation. This couldn’t be farther from the truth; instead the article discusses the proposition of matching HIV+ organ donors with HIV+ transplant recipients in an effort to decrease waiting list times and ultimately save and extend more lives. While the article is very informative, and stimulating, it strikes me as a little one-sided. It fails to mention (in reasonable detail) the already-existing donor and recipient selection criteria for patients (which can differ subtly between institutions and organ type…ie, some institutions do not transplant lung patients who have a bacteria known as Burkholderia Cepacia colonized in their lungs because of increased mortality after transplant^[1]), as well as the rationale behind them. Being able to transplant HIV infected organs into HIV positive patients would be a significant step toward increasing the donor pool, meaning more organs for more patients in need.

For as much research is ongoing to help patients after transplant, a lot of research needs to be focused on expanding our donor pool. (For example, a recent Toronto study that has shown that Ex-Vivo Lung Perfusion of marginal lungs outside the donor can be safely transplanted into a recipient, thereby effectively providing us the potential to utilize organs that we would normally not accept for transplant^[2]. More on this in a future article.)

The big “but” here however with this HIV+/Organ Donation proposal, includes the following:

As mentioned in the article, we have no way of knowing (at least in terms of a reliable data set) how different strains of the virus (as well as different stages) would impact the recipient – this would require probably much more detailed donor screening/testing to get an accurate idea- which isn’t always possible based on our small windows for organ viability. (For example, using HLA (Human Leukocyte Antigen) compatibility as a matching criteria for lung transplant is limited because of the amount of time it takes to do the test. Methods such as “virtual crossmatching” have been developed and are currently used to help predict what donor/recipient compatibility.)
HIV usually comes along with other infections (due to the immunnocompromised host) – this in itself might make the organ less viable.
It means that institutions as well as UNOS (United Network for Organ Sharing) have to come up with a very detailed and foolproof mechanism for ensuring non-HIV patients that they would never be offered an HIV infected donor.

There are other issues that would arise, but these strike me as the most obvious and concerning. That being said, identifying these concerns and finding ways to work through them and come up with solutions is the first step in making this proposition a reality. If appropriate measures are taken and preliminary research yields favorable results, this would encourage an educated decision regarding lifting the ban on utilization of HIV+ donors and potentially renew the lives of many HIV patients who are on a transplant waiting list. Thanks to years of research and dedication, today we transplant CMV (Cytomegalovirus) mis-matched donor/recipients and manage their post-op care with gancyclovir/valgancyclovir afterwards and they do very well. Granted CMV and HIV are different viruses, but it is still a step in the right direction. There are 5 days left for National Donate for Life Month, but the ambition, education, and research that this month embodies continues on in endeavors such as these.

REFERENCES:

1. Chaparro, C., et al. “Infection with Burkholderia Cepacia in Cystic Fibrosis.” Am J Respir Crit Care Med 2001; 163: 43-48.

2. Cypel, M., Keshavjee, S., et al. “Normothermic Ex Vivo Lung Perfusion in Clinical Lung Transplantation.” N Engl J Med 2011; 364: 1431-40.