D Gregory Smith

Should We Lift the Ban On HIV+ Organ Donation?

Filed By D Gregory Smith | April 11, 2011 6:00 PM | comments

Filed in: Living
Tags: Hepatitis C, HIV/AIDS, little red heart, Organ donation, organ transplant

When I was diagnosed with HIV, a friend said "You're an organ donor aren't you? You'd better change that."

I agreed, and Organ donationchanged my driver's license organ donor status (goodbye, little red heart!). But in the back of my mind I wondered "Why couldn't I donate to other HIV+ people should they need it? Surely having an infected organ and a few more years of life would be worth it." Especially now, when HIV (unlike, say Hepatitis C) is a very medically treatable disease. Not a picnic, but neither is renal failure.

Is it worse to have HIV than having to undergo weekly dialysis? Or to have a heart that works, or a liver, etc.? And if you already have HIV and need an organ, does it make sense that HIV+ donors be excluded?

Now it seems the feds are starting to think about the same things. According to the New York Times, The Centers For Disease Control And Prevention are about to issue new guidelines that will allow the study of HIV+ organ donation and transplantation.

It's about time. Literally.

What do you think? If it were about saving your life, would you accept an HIV+ organ? (img src)

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From what I know, the initial scare about creating a super-bug is actually far less common than initially believed, which is why there's a more lax approach concerning unprotected sex in the context of two monogamous HIV+ individuals.

In that light, I can see why the ban would be lifted. In the particular case of organ donation, the trade off is interesting, because people on organ donor lists have a much, much, much shorter life expectancy than an individual who has HIV (assuming adequate access to care, life expectancy is the same as an HIV- individual).

Blood is different, as blood is used in far more circumstances than "life or death". And the discussion here is on knowingly accepting organs containing HIV, rather than accepting blood and testing it for HIV before it goes into the supply.

I think my instinctual reaction was "of course not" to lifting the ban on organ donation, but in that perspective, I see the reasoning. Weighing the relatively low impact this would probably have on growth of HIV in the population, I can't really argue that it's a public health risk. Are the people who generally have access to donor lists and medical care necessarily the same populations as those that are most likely to transmit HIV? Something tells me no.

And if I'm in a situation where it's organ or no organ, assuming I have the medical care to facilitate living with HIV, I can't say I would reject it. Though I wonder, do people on organ donation lists generally already have compromised immune systems? If so, does HIV pose a risk of making recovery more difficult?

Really interesting topic.

SCVMalcolm | April 12, 2011 2:36 AM

Thanks for your thoughts, luminum....
What really irks me is that the Red Cross initiated the ban on gay men being able to donate blood early on and then last year pressured the powers to be to retain the ban, hence my local Church (Episcopal)refuses to have the Red Cross host our 3 annual Blood Drives. (The UK just granted permission for gay men to donate blood IF they have been sexually abstinent for 10 years.)
SO if gay men cannot donate blood, I'm really surprised that "they" would entertain the donation of organs from someone who has HIV. What happened to "exchanging body fluids"?

I think this is an unbelievable conversation to be having as LGBT people. We become outraged in the pages of Bilerico about diminished rights for transgendered people, expect that the right to marry is a basic right and demand equality in other parts of our lives; however, we want to cling to old fashioned, backwards and artificial ethics regarding HIV+ individuals. This is not a legislative issue, this is an individual decision. The only ethical issue is assuming responsibility for total transparency and and openness regarding status, but letting organs rot rather than allowing their transplant is simply ridiculous.

It's about stigma, mostly. Fear does amazing things- like hold off a study like this for decades...

Bingo! AIDS-phobia ia still used to manipulate the general population ... and it often seems so ridiculous to us LGBT's, because we are (or at least a large segment of us) more knowledgeable about the details on HIV, including quite a bit of the hard-core science ...

Well, it seems like allowing pos people to give organs to other pos people is obviously fine. While there are different strains of HIV, pos people are already so low on the recipient lists that the extra risk is definitely worth the reward. Which is a crucial point-people die on organ donation waiting lists. Less than ideal donors are better than nothing.

I don't see any moral or ethical reason to ban HIV-positive people donating organs to other HIV-positive people.

That said, in this country our bureaucratic machinery tends to value expediency over morality. With HIV-positive donors and recipients you'd have to screen for different strains of HIV.
There's also the fact that organ recipients have to go on immunosuppressants to prevent rejection of the organ. In an HIV-positive person with an undetectable viral load it might not be a problem, but I'm a little apprehensive about the kinds of hell antiretrovirals and immunosuppresants would wreak on a person's body, especially if they were in full-blown AIDS.

So, should it be lifted with protections in place to prevent infecting people with different strains of HIV or non-positive people (because I sure as hell wouldn't want to pay the medical bills for an organ transplant AND the medical bills for antiretrovirals and HIV treatments, and because we have a pretty clear message that HIV is not something you really want with all the sexual health awareness campaigns)? Absolutely.

Is it going to be? Probably not, especially while the GOP has got a stranglehold on the House.

Everything you say here is true. Meredith, but the real message of the HIV-ban is this: Scarce medical resources such as fresh, transplantable organs are not to be "wasted" on the dredges of society that get HIV in the first place. They need to go to fine, upstanding members of society (definitely having hetero families, and preferably middle- or upper-class and white).

The ban is a subterfuge by the medical industry to renege on going to the expense and effort to save a few extra lives that could be saved.

I agree, A.J. There is definitely this idea that donated organs can be "wasted" on recipients. For example, if you need a liver but you're a recovering alcoholic, you're not getting it because the medical industry thinks it would be a waste to prolong your life by even a few years if you're going to drink yourself to death again anyway.

It's really a pretty arbitrary system to decide who "deserves" to get a transplant.