Tranplant Discrimination Against those with HIV
American Journal of Transplantation (June '05) includes a fascinating study by Sydney Halpern and others at Penn in which a study of 347 surgeons revealed that there is some discrimination against those with HIV in terms of who gets an organ, and the reasons don't make sense in clinical terms.The 347 surgeons (56.1%) returning completed questionnaires believed that HCV- and HIV-infected patients have similar post-transplant survival (p = 0.9), but that both groups fare worse than HBV-infected patients (p < 0.00001 for both comparisons). Most transplant surgeons considered HBV- and HCV- infected patients to be appropriate transplantation candidates (p = 1.0 for this comparison), whereas one-third considered HIV-infected patients to be appropriate candidates (p < 0.00001 when compared with HBV- or HCV- infected patients). That surgeons are generally willing to transplant HCV- infected patients but not HIV-infected patients, and yet believe these groups will have similar post-transplant survival, suggests that survival estimates alone do not explain surgeons' choices. HIV-infected patients should have equal access to organs unless or until evidence emerges that they fare substantially worse than other potential recipients.[thanks Sean Philpott]
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...to read the whole thing. For example, the entire section which details "limitations" of the study as well as this:
"Another explanation is that while surgeons believe that HIV-infected patients will derive meaningful benefits from transplantation, they do not think these patients should be transplanted until ongoing studies document such survival. As a result, transplantation for HIV-infected patients has not yet been recognized as a standard of care."
Those of us who take care of transplant patients are also aware that the medications used for immunosuppression not only target the same arm of the immune system as HIV, but these drugs also interact unpredictably with the HAART medications.
If the surgeons questioned "believe these [HIV-infected] groups will have similar post-transplant survival" it is worth noting that such an affirmative belief is based on very little evidence, in very few patients, at very few centers, with very limited follow-up.
- by It might be prudent... on May 17, 2005 at 10:58 PM | link
the last comment raises the real fear of immunocompromise for these already compromised patients. The implication of discrimination may or may not be correct but there is also the concept of just allocation of scarce organs, including a responsibility to the donor that the organ will have a fair shot at providing someone a longer life.
- by sotto on May 19, 2005 at 12:03 PM | link