1 Tainted Organs HIV+ and Other Controversial and High-risk Organs Robert M. Veatch, PhD Professor of Medical Ethics The Kennedy Institute of Ethics Georgetown University Washington, DC 20057

2 Veatch, Robert M. Transplantation Ethics, Washington, DC: Georgetown University Press, Chapter 16: Tainted Organs: HIV-Positive and Other Controversial Donors

3 Tainted Organs HIV+ and Other Controversial Organs Diseased Organ Sources –HIV+ –Cancer –HTLV-1 –Hepatitis –Cytomegalovirus Other Risks –Age –Obese Donors

4Age Reluctance to place organs from older donors into younger patients Strange implication: advantage to the elderly –Elderly obtain all their normal allotment –Also obtain those declined for younger patients Proposal: Points (negative) for each decade difference in age between donor and recipient –Example of kidney: 20 y.o. donor and 60 y.o. recipient –Four negative points

5 Organ Sources at Risk for HIV HIV+ Donors Donors testing HIV-, but with High-risk Life-style

6 The Status of Recipients Thousands dying for lack of organs HIV is not an exclusion criterion for transplant Hundreds of organs are rejected as –(a) HIV-positive –(b) HIV sero-negative, but from high-risk donors

7 The Question: Imagine someone who is: –HIV+ –Stable, healthy and awaiting an organ –Dying for lack of an organ Should such people be offered organs from high-risk donors and would it be rational to accept such an offer?

8 Step 1: The HIV+ Recipient Offered a Sero-negative organ Risk is modest, but greater than zero –Blood content of organ modest –Chance that donor carries the virus is modest Concern that a second viral strain will increase the risk Once HIV+ patient decides to be lsited, it is very plausible to accept the offer of the sero-negative organ

9 Step 2: The HIV+ Recipient Offered a Sero-positive organ Risk is still modest, but greater than zero Once HIV+ patient decides to be listed, it may be rather plausible to accept the offer of the sero-positive organ Recipient may feel solidarity with the donor Recipient may altruistically wish to leave negative organs for negative recipients

10 Step 3: The HIV- Recipient Should High-Risk Organs Be Offered? Sero-negative organs from high-risk life- style donors –It may be rational to accept such organs if death is the alternative –Such patients should be listed with indicator of willingness to accept such organs Sero-positive organs –It may even be rational for negative recipient to accept HIV+ organ –More plausible to accept other high-risk organs: Cancer Hepatitis CMV

11 A Final Question: If offering high-risk organs is rational, why is there so much resistance? The possible reluctance of surgeons to handle HIV+ and other high-risk organs The reluctance of physicians to be directly responsible for their patients’ disease. –Physicians should have the right to refrain (cf. Right of physicians to refuse to perform abortion of assist in euthanasia) –Physicians should be encouraged to facilitate rational transplant of high-risk organs –It follows from their duty to do whatever will benefit their patients on balance