Solid-Organ Transplantation in HIV-Infected Patients

Before the introduction of highly active antiretroviral therapy in the mid-1990s, transplantation centers were understandably reluctant to provide scarce solid organs for patients infected with the human immunodeficiency virus (HIV). However, because treated patients can now expect to live substantially longer than before, many will have end-stage organ disease long before they have life-threatening conditions related to HIV infection. It is therefore time for the transplantation community to readdress the safety, efficacy, and propriety of transplanting scarce organs in HIV-positive patients who need them. In this article, we provide ethical arguments for viewing transplantation in patients with HIV infection as analogous to transplantation in patients with other chronic illnesses. Accordingly, transplantation in HIV-positive patients should be initiated at major centers and should not be considered experimental. In addition, reimbursement for such procedures should be similar to that for transplantation in other patients, unless evidence accumulates that HIV-infected transplant recipients fare poorly.