Monday, December 2, 2013

A WHOLE LOTTA HOPE

After an organized, well fought, and fully bi-partisan effort, the HOPE (HIV Organ Policy Equity) Act became U.S. law, signed by President Obama on November 21, 2013. This new legislation removes the previously existing legal barrier to all research on the transplantation of HIV-positive organs in humans.  Present at the legislative signing were the President-elect of the American Society of Transplant Surgeons, Dr. Peter Stock and the President of the American Society of Transplantation, Dr. Dan Salomon. As previously noted HIV-positive transplant candidates had been legally prohibited from receiving HIV-positive organs by the Organ Transplant Amendments Act of 1988, even though cautious exploration of this strategy (a logical potential step in expansion of the too small pool of donor organs) was widely supported.

The logic thread is based on successful transplant outcomes with Hepatitis C. With this infectious disease, organs from infected (or potentially infected) donors are transplanted into recipients known to already be infected with the same virus. This clever strategy, while avoiding the transmission of a new disease (since the recipients are already infected with it) and thereby causing a brand new problem at the time of transplantation, is actually a means of successfully expanding the too small pool of deceased donor organs. Of course, the recipients must be informed about the donor's infection and asked for consent in advance - many (but not all) do agree to proceed. Long term results of liver and kidney transplants for previously infected recipients have been equivalent for those receiving either Hepatitis C -ve or +ve organs. And, future results in both circumstances may prove even better with the advent of new, highly effective anti-viral Hepatitis C drugs. So, instead of completely wasting the organs from a Hepatitis C +ve donor, they are ADDED to those effectively transplanted - saving lives.

Now, it will be possible to explore the possibility of transplanting HIV +ve organs into HIV +ve recipients. In fact, we have long had better anti-retroviral therapies (to treat HIV) than anything available for Hepatitis C. Yet the 1988 law had halted all potential progress. But not now! So, let's move forward.......consider further broadening the breadth of donors (maybe even living donors who are HIV +ve?) and helping a specific subset of transplant candidates. This was/is a win-win for all.

1 comment:


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