sábado, 1 de diciembre de 2018

HIV and Organ Transplants

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By Sally Robertson, B.Sc.Reviewed by Susha Cheriyedath, M.Sc.

The risk of HIV infection as a result of receiving an organ transplant is low. All organ donors undergo screening for HIV risk factors and are tested for the infection. However, although HIV testing is very accurate, the test can fail to detect HIV in individuals who have only been exposed to the virus very recently. Thus unexpected transmission to patients receiving a transplant from infected donors has been reported.

In the U.S., a Public Health Service agency called the Health Resources and Services Administration is responsible for overseeing the procurement and transplantation of organs. This agency ensures adherence to policies outlined by the Organ Procurement and Transplantation Network, which require that potential organ donors must undergo specific screening before their organs can be deemed suitable for transplantation.

The 2013 Public Health Service guidelines state that all people who donate organs, whether alive or deceased, are screened for HIV. The guidelines also advise that the most recently developed and most sensitive tests are used for screening so that recipients of donated organs can be informed of any risk and protected from infection to the greatest possible extent.

HIV Organ Transplantation

HIV organ transplantation is the concept of transplanting organs from HIV-positive individuals to other people who are also HIV-positive. Currently, research involving HIV-infected organs is banned under federal law in the US, as a result of an amendment made in 1988 to the National Organ Transplant Act. At that time, AIDS was generally considered to be a death sentence and it was written into congressional law that scientists could not perform research involving HIV-positive organs.

In the US, more than 120,000 individuals are in need of new lungs, hearts, kidneys, and various other organs and among those individuals are people with HIV. Researchers say that allowing the transplant of HIV-positive organs to people who already have the infection could help to ease this demand, making an additional 500 to 600 organs available every year. As well as saving hundreds of lives, this would significantly reduce the waiting time for uninfected people who are in need of an organ transplant.

Through collaboration with HIV organizations, US senators Tom Coburn and Barbara Boxer developed legislation to lift the federal ban on this type of “positive-to-positive” transplant and introduced the HIV Organ Policy Equity (HOPE) ACT. The US government signing the HOPE Act will allow the Department of Health and Human Services to oversee the Organ Procurement and Transplantation Network so that the guidelines required for this type of transplant can be developed.

In a very recent announcement, researchers at the Johns Hopkins University School of Medicine in Baltimore said they have received approval to start performing the first positive-to-positive transplants. Surgeons at the medical school say they are planning to conduct kidney and liver transplants as soon as the right recipients become available.

Dr Dorry Segev, a surgeon at the university who has been working for years to allow this type of transplant, says that hundreds and possibly thousands of people could now be taken off the donor organ waiting list meaning everybody behind them can move forward on the list. “People with HIV are benefited directly and everybody else on the list is benefited indirectly. And we're all very excited to get started”, says Dorry Segev.