Organ Transplants for HIV+ Patients?
June 15, 2001 8:03 AM   Subscribe

Organ Transplants for HIV+ Patients? The Starzl Institute, one of the most prestigious organ transplant centers in the nation, is making waves in the medical and transplant community by offering new organs to patients with HIV and AIDS. (They are currently evaluating Larry Kramer, co-founder of GMHC and Act-Up for a new liver.) Is this progressive, compassionate medicine, or is it, as some critics have charged, a waste of scarce organs that could go to patients who don't have an underlying fatal virus?
posted by Dreama (23 comments total)
Wow, I've never seen a Metatalk post that required such tip-toeing before. My thoughts are that if medicine is willing to give a new liver to David Crosby, we damn well better give an HIV positive person access to the same waiting list. Unfortunately, I imagine that the ticking clock and evil insurance companies undercut this dilemma more than we would care to admit.
posted by machaus at 8:22 AM on June 15, 2001

meant metafilter... but you knew that...
posted by machaus at 8:24 AM on June 15, 2001

I'm actually interested to hear what you think, Dreama. If I follow the logic right, a conservative would believe that the organs should be distributed to those who can afford them, regardless of need.
It is a touchy issue, though, but distributing organs based on the patients need and the risk involved seem like the best way to me.
posted by Doug at 8:33 AM on June 15, 2001

Part of the problem in discussing this is a lack of general awareness - on my part as much as in the population as a whole - of what the evaluation criteria are for transplant acceptance in the first place. I'll be the first to admit that I find Kramer absolutely intolerable and have, on many occasions, wished he would simply go away. Now, he has liver disease in addition to being an asshole and being HIV-positive, and the liver condition is not related any more to either of those two conditions than it would be to the alcoholism that caused the liver conditions of people who have been granted transplants. Make no mistake, I still want him to go away. But I think, based on what little I know of the criteria, that he qualifies as much for the transplant as most other cases, as would any HIV-positive individual who's general prognosis was stable.
posted by m.polo at 8:45 AM on June 15, 2001

An AIDS diagnosis isn't a certain-death sentence anymore, so I think AIDS patients should have access to transplants. But fixing the organ shortage would be a better solution than picking and choosing who gets transplants.
Spain did it - now they export the organs they don't need to other countries. In Spain, as with many other countries in Europe, when a person dies, consent for organ donation is assumed unless the person has opted out - by placing their name in a national registry, or in cases where the family strongly objects.
posted by hazyjane at 9:01 AM on June 15, 2001

Doug, your logic has failed you, yet again. Nice try.

I'm with m.polo. If your HIV disease is under control, then there's no reason why you should not be eligible for a transplant. I'm actually more stunned that most transplant centres consider HIV+ status, not health of patient regardless of HIV status, a compelling reason to not consider someone transplant-eligible. I think that their arguments (wasted time, wasted organs) fall flat on their faces, especially in an era where we can point to a growing number of people who have survived nearly twenty years with HIV.
posted by Dreama at 9:04 AM on June 15, 2001

Yet again? Anyway, if you'll notice, Dreama, I never mentioned AIDS, but need. Pretty silly to get snotty when you don't even seem to understand the post.
Now, it seems you are for the distribution of organs on the basis of need. That's nice. But you are, I'm sure, very much against the distribution of ANYTHING else on earth based on need. Why is that? Would you be for money being distributed based on need? Even food? Energy? I doubt it. It seems to me like an inconsistancy in the conservative philosophy.
posted by Doug at 9:21 AM on June 15, 2001

i want to participate in this discussion, but i feel ill-equipped to do so. i put my trust in the hands of responsible physicians to make these difficult decisions and hope that my life will never be touched by tragedy which would inform me enough to be able to answer this tough question.

(i also hope that doug & dreama will lay off the personal flames, but that's neither here nor there)
posted by palegirl at 9:42 AM on June 15, 2001

Hmmmm. Let's see now; organ transplant patients need to be immunosuppressed to prevent tissue rejection.

HIV patients are given antivirals and therapies to improve their immune system.

I'm not trying to be a smartass, but am I the only one to see a general conflict in therapy goals here? Am I missing something? Granted, therapies can target different parts of the immune system, but is it safe to immunosuppress an HIV patient?
posted by Alwin at 9:44 AM on June 15, 2001

Immunosuppression is dangerous for anyone, regardless of HIV status. That's why transplant recipients are sequestered in contamination-free areas for a while following the procedure. When you've had your entire immune system gutted, HIV status ceases to matter, really--any opportunistic infection can kill anyone. It then just becomes a matter of restoring said immune system, something that AIDS therapies have gotten pretty good at.
posted by Skot at 9:58 AM on June 15, 2001

Alwin, you've hit it on the head. I know a little about this since I'm donating a kidney to my brother NEXT WEEK (this will be his 2nd transplant in 15 years). The number of tests both donor and recipient have to go to is overwhelming. I believe that this issue really comes down to 2 factors:

1. How will the operation itself affect the health of the person recieveing the organ.

2. Who will be benefited the most (most needed) from recieving an organ.

That is the problem, with a person with HIV would be on immunosupressants in order to keep the organ working. And I don't care how "pretty good" they've gotten at "restoring" the immune system, non-HIV+ people have a hard enough time and run enough risks as it is.
posted by tj at 10:22 AM on June 15, 2001

Sorry, forgot a point... with cadaver organs (which is what we're talking about here) immunosuppressants are ALWAYS needed
posted by tj at 10:25 AM on June 15, 2001

pretty well offtopic, but here I go anyway: wow, tj---that's amazing, and not a little scary I bet---good luck, I hope both you and he come through with flying colors.
posted by Sapphireblue at 10:28 AM on June 15, 2001

i feel that the distribution of organs to HIV+ patients can be ethical*. i remember a bit about UNOS (United Network for Organ Sharing) from my bioethics philosophy class i took about a year ago, and in particular, i remember very strict guidelines in place to govern the distribution of organs to others.

first off, people are on a waiting list modeled as a priority queue. your situation may push you up the list if need be, or may start you at the end of the line instead. if you are terminally ill, UNOS would probably deny you an organ--understandably so. but HIV is a different beast than it was in the '80s. you can take an AIDS coctail to virtually freeze the progress of the disease in your body, so i feel that should not be counted against you AS LONG AS unos can be reasonably assured you will continue to take the medication. that's a big if.

another complication of course is the combination of the AIDS coctail and similar meds with the anti-rejection drugs needed for those with transplanted organs. how will they react? can they coexist together? i can't answer that question off hand.

another complication might sound kind of mean off hand, but it does count. if you are HIV+ you are probably not going to have children, and that does factor. UNOS would rather give an organ to someone in a case that would not just significantly improve the quality of life for the individual but also those affected by them, so questions such as: do you have your own family, or will you, are important.

if unos could ever be given sufficient guarantee you will take your meds for the HIV as well as the anti-rejection drugs, i would argue that unos still ought to start you off at the end of the line simply because the only benefit the organ will have will be to the individual, unless the individual truly does have dependents (in which case you might want to bump them up). but i will say i don't think they should strike you from the list right off.
posted by moz at 10:52 AM on June 15, 2001

These are exactly the sort of conundrums that piss me off so when people attempt in anyway to hinder cloning research.
posted by dong_resin at 11:53 AM on June 15, 2001

Palegirl, you're right, I apologize for being such an ass, but I was taken aback by Dreama being such a prick when I asked an honest question. I really was curious to know what a conservative thinks about organ distribution, and since he started the thread, I assumed he had an opinion.
posted by Doug at 12:36 PM on June 15, 2001

Doug, first out, I'm very much a she, thank you.

Second, I avoided your question because a.) I do not like your attitude nor your need to make presumptions about my thoughts based on my political persuasions. b.) I am not the postergirl conservative on MeFi and I will not act as one to satisfy your demands. I posted my thoughts on the subject at hand, and if that doesn't suit you or anyone else, tough.
posted by Dreama at 4:33 PM on June 15, 2001

a little off-topic (maybe)? for those curious about the hidden side of HIV and AIDS...

The AIDS Heresies
posted by mcsweetie at 6:06 PM on June 15, 2001

1) Doug & Dreama: flame on!

2) This is simply an absurd argument. We are all dying. From birth, our bodies are going through a process of aging which will eventually lead to death. So using the argument that someone has contracted some kind of life-limiting disease and therefore shouldn't be eligible for the same and equal treatment as any other, is like telling someone with allergies they should be denied the use of tissue paper cuz they might affect the supply of Kleenex to the rest of the world. Absurd.

Medicine's purpose is to improve the quality of life and stave off the inevitable, be it from old age or AIDS. The potential cause of death is irrelevant in the perpetual fight for life that is medicine. Any doctor worth his/her salt would tell you that, whether they are liberal or conservative. Of course a conservative doctor might add a caveat regarding economics, but the gist of the message would be the same.
posted by ZachsMind at 11:15 PM on June 15, 2001

OK fine then, Zach. Using your analogy:
Using tissue paper could KILL the person using it. Please, this is not a simple or unimportant issue in any way shape or form do not treat it a such.
posted by tj at 7:52 PM on June 17, 2001

tj--Good luck, my thoughts will be with you. Let us know how you're doing.
posted by rodii at 8:46 PM on June 17, 2001

thanks... will do... (though I don't like sidetracking this particular conversation) the operation will be on the 20th for those interested.
posted by tj at 8:58 PM on June 17, 2001

Sorry to hijack this thread (it seems pretty inactive anyway) The operation went amazingly well. I am at my parents' house recovering (without my email :( ) and my brother's new kidney seems to be fully functional.

Again, thank you all for the kind words. They were appreciated.
posted by tj at 11:10 AM on June 22, 2001

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