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In 2013, the U.S. government passed the HIV Organ Policy Equity (HOPE) Act, which allows research to be conducted on the safety of organ donation from deceased donors with HIV to recipients with HIV. A new study published in the American Journal of Transplantation explores the quality of these organs and how their use might impact the country's organ shortage.
In the United States, there are not enough organ donors to meet the needs of all patients who might benefit from life-saving organ transplants. Some patients waiting for organs are infected with HIV, and they generally do well after receiving a transplant. In South Africa, HIV-infected individuals have been a valuable source of organs for HIV-positive patients in need of kidney transplantation. To examine whether this is a viable option in the United States, Emily Blumberg, MD, of the Perelman School of Medicine at the University of Pennsylvania, and her colleagues explored how many potential HIV-infected organ donors there might be in a large American city (Philadelphia) where many HIV-positive patients are currently waiting for a transplant. The team reviewed the records of HIV-infected patients who were followed regularly at six busy outpatient centers and who died during a 5.5-year time frame.
"Using standard criteria for donor selection, we estimated that annually there were four to five potential donors in our area; these individuals might be a source of two to three kidneys and four to five livers," says Blumberg. "If we extrapolated our results to estimate the national possibilities, nearly 400 potential organ donors might be available annually."
Unfortunately, standard measurements of organ quality suggest that many of these donor kidneys may be of reduced quality with decreased viability over the long term when compared with ideal donor kidneys, Blumberg notes. This may reflect ongoing success in treating HIV-infected individuals who now live longer and are more likely to die due to cardiovascular causes, hepatitis, and cancer, conditions that may affect their overall suitability as organ donors. The quality of the livers that might have been obtained from these donors was better, although a number of the potential liver donors were also infected with hepatitis C virus, which can compromise liver health. Given the growing availability of effective therapies for hepatitis C, these organs may be a better option in the future.
"Because patients may potentially benefit from expanding the donor pool to include HIV-positive organ donors for HIV-positive recipients, it is important to understand how to optimally use this possible new source of transplant organs," says Blumberg. "Our findings suggest that it will be important to explore parameters related to long-term organ viability when assessing the potential impact of using HIV-infected organ donors for HIV-infected patients." The results could also help inform the ongoing process of implementing the HOPE Act.