UNOS: Each center must make decision
UNOS: Each center must make decision
Not everyone was as enthusiastic as researchers when transplant surgeons suggested the possibility of opening liver transplant procedures to HIV-positive patients. Researchers shared their experiences with liver transplants in HIV-positive patients at the International Liver Transplantation Society in Pittsburgh in late August.
"It seems almost crazy to be exploring new possibilities for transplant when the shortage is so severe," says Arthur Caplan, MD, director of the Center for Bioethics at the University of Pennsylvania in Philadelphia. "You don’t want to discriminate against anybody, but you want to take into account the chances of success and the likelihood that people will live with the transplant."
Each transplant center will have to reach its own conclusion. That’s the word from the United Network for Organ Sharing (UNOS) in Richmond, VA. UNOS is the nonprofit organization that administers the nation’s organ transplant network.
"We don’t have a specific policy that addresses HIV-positive patients. We don’t actually say that they should perform transplants in these patients, but we certainly don’t prohibit it," says Bob Spieldenner, UNOS spokesman.
While UNOS sets overall organ allocation policy, it basically sets priorities for allocation based on geographic area and the severity of a patient’s illness in order to list candidates for donation, adds Spieldenner.
Changes comes from within
It’s up to individual centers to develop clinical criteria on which patients would be good transplant candidates and which patients wouldn’t, he says.
"Most places do not transplant patients with HIV because there is the perception of such a short life expectancy, I believe. If there is a change, it would come from the center itself," he explains.
The University of California San Francisco is considering doing just that. The transplant center plans to use a $1 million state grant to conduct up to 10 liver transplants in HIV-positive patients. The candidates must have undetectable viral load levels, normal CD4 levels, and no AIDS-related illnesses.
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