title: Allowing HIV-positive organ donation: ethical, legal and operational considerations.
abstract: Case reports of kidney transplantation using HIV-positive (HIV+) donors in South Africa and advances in the clinical care of HIV+ transplant recipients have drawn attention to the legal prohibition of transplanting organs from HIV+ donors in the United States. For HIV+ transplant candidates, who face high barriers to transplant access, this prohibition violates beneficence by placing an unjustified limitation on the organ supply. However, transplanting HIV+ organs raises nonmaleficence concerns given limited data on recipient outcomes. Informed consent and careful monitoring of outcome data should mitigate these concerns, even in the rare circumstance when an HIV+ organ is intentionally transplanted into an HIV-negative recipient. For potential donors, the federal ban on transplanting HIV+ organs raises justice concerns. While in practice there are a number of medical criteria that preclude organ donation, only HIV+ status is singled out as a mandated exclusion to donation under the National Organ Transplant Act (NOTA). Operational objections could be addressed by adapting existing approaches used for organ donors with hepatitis. Center-specific outcomes should be adjusted for HIV donor and recipient status. In summary, transplant professionals should advocate for eliminating the ban on HIV+ organ donation and funding studies to determine outcomes after transplantation of these organs.
authors.affiliation: University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
authors.forename: O
authors.initials: O
authors.lastname: Mgbako
authors.forename: A
authors.initials: A
authors.lastname: Glazier
authors.forename: E
authors.initials: E
authors.lastname: Blumberg
authors.forename: P P
authors.initials: PP
authors.lastname: Reese
mesh_terms: D004992:Ethics, Medical; D006679:HIV Seropositivity; D006801:Humans; D016377:Organ Transplantation / Q000941:ethics / Q000208:ethnology / Q000379:methods; D012307:Risk Factors; D014019:Tissue Donors / Q000941:ethics / Q000331:legislation & jurisprudence / Q000600:supply & distribution; D009927:Tissue and Organ Procurement / Q000941:ethics / Q000331:legislation & jurisprudence / Q000379:methods