Harris Supports HIV-to-HIV Transplant Bill

The Daily Times

Jennifer Shutt

Since organ transplants began increasing during the 1980s, there has been one group of Americans prohibited from giving their organs to continue life after their death.

Those with HIV cannot donate to or receive organs from other HIV-positive patients.

“In the 1980s, when the National Organ Transplant Act was being written, we were in the middle of the AIDS scare, so it made sense that there would be stipulations to AIDS and the virus that started AIDS,” said Dr. Dorry Segev, director of clinical research in transplant surgery at Johns Hopkins Medical Institute, who was a driving force behind introduction of legislation to change the policy.

In the 25 years since that bill was passed by Congress, doctors and society have learned much more about HIV, yet those with HIV are still barred from donating organs to other positive patients.

To permit organ donation to HIV patients from HIV patients, Republicans are working with Democratic colleagues in what appears to be a rare, bipartisan effort on health care in Washington. The bill may be aptly named the HIV Organ Policy Equity Act, or the HOPE Act.

Eastern Shore Congressman Andy Harris, a Hopkins physician himself, is one of the co-sponsors.

He said the policy excluding ­HIV-positive patents from donating to other HIV-positive patients is “outdated” and needs to be revisited by Congress.

“We have to think outside the box to provide donor organs to whoever is in need of a transplant,” Harris said.

While the intent of the original law was to protect people from becoming infected with the virus, that section may now be causing more harm than good.

“People with HIV are living full lives and, in fact, they are getting the chronic diseases everybody else gets and they need transplants like everyone else,” Segev said.

Some might find Harris’ name listed among some quite liberal Democrats surprising, or might consider it hopeful that the talking points of “bipartisan cooperation” are a bit more than folly for Capitol Hill speech writers.­

He has a different view, saying most of the time, members of Congress agree on the need to keep health laws up to date with science and medical research.

“Although the Affordable Care Act took health care and created a partisan atmosphere on that aspect, I think more people would feel health care is a bipartisan issue and I think this bill is a perfect example of it,” Harris said.

Introduced in the Senate by California Sen. Barbara Boxer and in the House by California Rep. Lois Capps, the bill would allow for a closely monitored trial of HIV-to-HIV organ donation by the Department of Health and Human Services before it would be permitted in all United Network of Organ Sharing, or UNOS, approved hospitals.

The Senate version passed with unanimous consent this week, but the House bill, which has 30 co-sponsors, has yet to get out of committee.

If it passes the House and is signed in to law by President Barack Obama, it would not be the first time HIV-positive patients have received organs.­

Joel Newman, assistant director of communication at UNOS, said those with the virus have been receiving organs transplants from non-HIV patients since the early 1990s.

At first there was concern the medicines given immediately following transplant surgery, which lower the immune system’s response, would have a devastating effect on a patient’s already weakened immune system. But changes in dosage and a better understanding of how HIV acts within the body have virtually eliminated that concern.

“It wasn’t an absolute prohibition, but it was very unlikely HIV patents would have been listed for transplant,” he said. “Twenty years ago, those medicines were given at much higher doses; the response for someone was unknown and there were a lot more medical questions and risks.”

Since then, HIV-positive patients have begun to regularly receive organs from non-HIV patients. Last year — in states that allow the data to be given to UNOS — 198 of 28,000 transplants were to HIV-positive patients. But Newman and Segev believe the real number of transplants is much higher.

Segev believes between 500 and 1,000 patients would receive an organ from HIV-positive donors every year if the legislation becomes law. That would also free up between 500 and 1,000 organs a year for non-HIV patients.

“This would probably be the biggest increase in our donor pool in the last decade,” Segev said.

Ronald Johnson, vice president of policy and advocacy at AIDS United, agrees advancements in pharmacology and medical understanding of HIV and AIDS have led to people living longer, healthier lives. To further that, he and AIDS United support moving forward to allow HIV-to-HIV organ donation.

“It is a sort of limited potential population that would be affected, but for that population it’s a very important opportunity that will enable them to live longer and live productively,” he said.

Based on research he’s done, Segev said the list for HIV-positive patients waiting for an organ would be short compared to where they may land now. The time for non-HIV patients could also reduce if HIV patients have access to a previously restricted source of organs.­

If the program is approved, the organs going to HIV patients would be from HIV patients who had died of causes other than AIDS, such as a car crash or aneurism. No patient who dies of complications from the virus would be eligible to donate their organs.

Newman said for those who would qualify, decisions would still be made on a case-by-case basis by the transplant team.

One of the points doctors and researchers will have to address is what affect giving a patient with one type of HIV an organ from someone with a different type of the virus would have.

According to most infectious disease specialists Segev has spoken with, the antiretroviral drugs available today would alleviate many of those concerns.

“The concern would be that if you have someone who is stable on HIV treatment and you give them a different version of HIV,” he said. “But, almost every version of HIV out there has a drug that can treat it, so at most the challenge would be switching the drug regiment for the patient.”

In South Africa, where HIV-to-HIV organ donation has been taking place for years, the outcomes appear to be quite good, according to Segev.

If similar organ donations become legal in in the U.S., the 118,474 patients waiting in hospital beds and homes for lifesaving donations could have a shorter wait. And just maybe the 7,000 family members who die each year waiting on the list will shrink and dwindle, and one day they won’t be a statistic at all.