Since the HIV epidemic began, those in the United States diagnosed with HIV have been barred from donating organs or having their organs donated. That is about to change when Johns Hopkins performs the first kidney and liver transplants from HIV-positive donors to HIV-positive recipients.
At the height of the AIDS epidemic twenty-eight years ago, an amendment to the National Organ Transplant Act was passed, effectively banning those with HIV from donating organs for transplant. At the time, an HIV diagnosis was considered a death sentence (90% of those diagnosed between 1988-1992 died), and those diagnosed carried the label and stigma with them. Because death rates were so high, those who may have needed a transplant were pushed aside with the logic that they would not have long to live anyway, and that someone else could make better use of a long-awaited transplant. Those who were HIV-positive who may have wanted to donate were also turned away for fear of spreading the virus to those who were not diagnosed.
Those with HIV now live longer, thanks to modern medical advances (only 23% of those diagnosed between 1996-2000 died – one third of the total deceased, compared to 1988-1992), although with a caveat: these medicines can cause kidney and liver damage so severe as to necessitate a replacement. Even though mortality rates have been decreasing since the early 1990’s, up until recently, those with HIV were not eligible for placement on the organ transplant recipient waiting list, despite their increased risk of organ failure.
With the signing of the HIV Organ Policy Equity Act in 2013 and approval from the United Network for Organ Sharing this January, transplants between two HIV-positive people are possible. This is not only a success from the perspective of social and health justice for those who are HIV-positive, but also for the entire organ transplant system.
Waiting lists for organs are incredibly long – there are about 122,000 people currently on the list – and often people don’t even live long enough to ever receive their transplant. Now that transplants between HIV-positive donors to HIV-positive recipients are legal, there is an additional source of viable organ donations, which can save more than 1,000 people every year. Waiting times for all recipients will be shorter, and this is especially true for those with HIV, as they are the only ones allowed to receive the HIV-positive donations.
The stigma surrounding those who are HIV-positive continues to fade as the opportunities for proper medical services grow. Like the recent blood donation policy revision that allows gay people to donate (with certain conditions), a broader acceptance of otherwise marginalized populations has the potential to save thousands more lives every year.
