Ethicists Argue That HIV Patients Should Have Equal Access to Transplants

Patients who are HIV-positive and need an organ transplant should have equal access to organs from cadaver donors, three medical ethicists argue in the current issue of the New England Journal of Medicine.

Dr. Arthur Caplan and Scott D. Halpern of the University of Pennsylvania and Dr. Peter Ubel of the Veterans Affairs Ann Arbor Healthcare System in Michigan argue that drugs have turned HIV into a chronic infection that isn't necessarily a death sentence, and that many people infected with the virus now live for years.

They further contend that there is no evidence to suggest that the immunosuppressive drugs taken by transplant recipients increase an HIV patient's susceptibility to infection.

The researchers note that most transplant programs offer organs to people with other conditions that can affect how long they survive such as hepatitis C and diabetes.

"On ethical grounds alone, there is no justification for providing organs to these groups of patients but not to patients infected with HIV," the authors write.

With more than 80,000 Americans on growing transplant waiting lists, many transplant surgeons have been opposed to using scarce organs for HIV patients. But in the past couple of years, this view has begun to change.

A spokesperson for the United Network on Organ Sharing (UNOS), which coordinates distribution of organs, said its figures show that in 2001, 26 HIV-positive patients received donor kidneys and 22 received liver transplants. The actual total would be somewhat higher because California and a number of other states prohibit disclosure of a patient's HIV status.