An Exception to the Rule or a Rule for the Exception? The Potential of Using HIV-Positive Donors in Canada.
Selected human immunodeficiency virus (HIV)-infected patients with end organ failure can safely receive an organ transplant from an HIV uninfected donor. Recent demonstration of the short term safety of organ transplantation between HIV-infected persons prompted a change in US American law to allow such transplantations. Prompted by the recent completion of the first organ transplantation between HIV-infected persons in Canada, we review Canadian law regarding the use of organs from HIV-infected donors, estimate the number of potential HIV-infected donors in Canada, and critically review considerations related to advancing organ transplantation from HIV-infected donors in Canada. Existing legislation allows organ transplantation from an HIV-infected donor under exceptional medical circumstances and therefore no change in legislation is required to increase utilization of organs from HIV-infected donors for transplantation in Canada. Among 335,793 hospital deaths between 2005 and 2009 in Canadian provinces excluding Quebec, 39 potential HIV-infected donors were identified. The actual number of HIV potential donors is estimated to be approximately 60% lower (3-5 potential donor per year), if the absence of viremia is required for transplantation. Although offering all Canadians the opportunity to donate organs is a laudable goal, further research to understand the need for HIV-positive donors and the willingness of HIV-positive recipients to accept organs from HIV-positive donors is needed to inform future policy regarding organ donation from HIV-infected persons in Canada.
1 Division of Infectious Disease, University of British Columbia, Vancouver, British Columbia, Canada. 2 Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada. 3 Health Law Institute, Faculty of Law, University of Alberta, Edmonton, Canada. 4 Département de Medicine, Centre Hospitalier Universitaire de Montréal, Montreal, Canada. 5 Research Centre of Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada. 6 Montreal Cancer Institute, Montreal, Quebec, Canada. 7 Nephrology Division, CHUM and Department of Medicine, Université de Montréal, Montreal, Quebec, Canada. 8 Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.
Alissa J
AJ
Wright
Caren
C
Rose
Maeghan
M
Toews
Michel
M
Paquet
Daniel
D
Corsilli
Jean-François
JF
Le Cailhier
John S
JS
Gill
D002170:Canada / Q000453:epidemiology; D046148:Donor Selection / Q000331:legislation & jurisprudence; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology*; D006291:Health Policy; D006801:Humans; D016377:Organ Transplantation / Q000009:adverse effects / Q000331:legislation & jurisprudence / Q000379:methods*; D061214:Patient Safety; D018570:Risk Assessment; D012307:Risk Factors; D014019:Tissue Donors / Q000331:legislation & jurisprudence