Deceased donors with HIV could extend organ pool

Last Updated: 2015-05-22

By David Douglas

NEW YORK (Reuters Health) - Livers and kidneys from HIV-infected deceased donors (HIVDD) might boost U.S. supplies of donor organs for HIV-positive recipients by hundreds per year, according to an assessment by Philadelphia-based researchers.

Many questions remain, but Dr. Emily A. Blumberg told Reuters Health by email that "HIV patients are now living longer with better control of their HIV infection -- this means that they are typically developing other conditions that may lead to their death or make them candidates for life-saving organ transplants."

"HIV-positive organ donors have been used successfully in South Africa," she added, "and research is now being considered that would allow us to use HIV-positive organ donors for HIV-positive recipients."

In a paper online May 14 in the American Journal of Transplantation, Dr. Blumberg of the University of Pennsylvania and colleagues note that in 2013 the HIV Organ Policy Equity (HOPE) Act, legalized organ donation from one HIV-infected person to another in a research setting.

But, they add, "The potential contribution of HIV-infected organ donors in the United States is unknown, both in terms of quantity and quality of organs that may be available."

It is unknown how many HIV-infected patients die waiting for a transplant, the team notes. They estimate that 80 to 100 are on the waitlist in Philadelphia, with 5 to 10 transplanted every year.

To examine the possible role of HIVDD, the researchers studied data on 578 HIV-positive patients who died in the Philadelphia area between 2009 and 2014. After exclusions for reasons such as not being on mechanical ventilation, and no documented brain death, the team identified 13 potential donors who died in care.

Compared to more than 600 Philadelphia-area donors without HIV, the potential HIVDD were older, had a higher prevalence of diabetes, hepatitis C virus positivity and poorer organ performance ratings.

As Dr. Blumberg pointed out, "Ironically the greater success in treating HIV may mean that potential organ donors may have other conditions that may affect the function of the transplant organ (for example high blood pressure), something that we will need to consider as we determine which HIV positive individuals could qualify for deceased organ donation."

Nevertheless, extrapolated nationally, the researchers estimate that there would be around 356 potential HIVDD yielding 192 kidneys and 247 livers annually.

"There is a shortage of available organs for end-stage diseased patients in the US, and as such, it is imperative that we identify ways to optimize the organ supply, particularly for vulnerable populations," said Dr. Jayme E. Locke of the University of Alabama at Birmingham, who was not involved in the study.

"For HIV-infected end-stage patients, HIVDD may provide a viable opportunity for overcoming the organ shortage, and the implementation of the HOPE act has now made this possible. The success of HIV-to-HIV transplantation in the setting of the US HIV epidemic remains to be determined," Dr. Locke, an assistant professor of surgery in the division of transplantation, told Reuters Health by email.

"Questions linger about donor quality, and the spread of multi-drug resistant HIV and opportunistic infections, and highlight the need for research protocols to study HIVDD and HIV-to-HIV transplant," Dr. Locke said.

SOURCE: http://bit.ly/1SmVZ3P

Am J Transplant 2015.