U.S. Congress Moves Closer to Lifting Ban on
Transplanting Organs From HIV-Positive Donors
Sciencemag, by Senah Sampong on 19 July 2013, 12:30 PM |
A U.S. House of Representatives committee this week unanimously approved a bill approving transplants using organs taken from people infected with HIV. The HIV Organ Policy Equity Act would lift a nearly 3-decade-old federal ban on such transplants and allow expanded research into the outcomes of transplant patients. Similar legislation has already passed the Senate, and the bill's advocates say that the policy shift could save hundreds of lives each year if it ultimately makes it into law.
"The shortage of organ donations in our country is a critical matter," said Representative Lois Capps (D-CA), who introduced the bill, in a statement. "We need to begin to research the feasibility and safety of these transplants in hopes that more people can receive transplants, and more lives can be saved."
Congress banned transplant of HIV-infected organs in 1988, when AIDS was rapidly spreading and little was known about how to prevent and treat it. A concerted effort to lift the ban began about 2 years ago, after a 2011 study published in the American Journal of Transplantation (AJT) concluded that the ban was outdated and that these organs could help fill a gap between supply and demand.
Today, there are more than 118,000 people in the United States on the waiting list of the Organ Transplant and Procurement Network, a nonprofit established to coordinate the transplant system. Perhaps 1000 people on the list are HIV-positive, researchers estimate. Antiretroviral drugs can extend the lives of these patients, physicians say, but many are vulnerable to kidney failure, and adding more HIV-positive organ donors to the pool would give them a better chance of survival.
"We should really offer them transplants as a cure for kidney failure," says Mohamed Atta, an associate professor of medicine at Johns Hopkins University in Baltimore, Maryland. In the past, he says such "positive-to-positive" transplants were "not even an option for those patients and that was discrimination."
The pool of potential HIV-positive organ donors is about 500 per year, according to the 2011 study by researchers at Johns Hopkins that was published in AJT. These donors could provide an additional 1000 organs, says transplant surgeon Dorry Segev of Johns Hopkins, who worked on the study. "If we were able to successfully use all those organs, we would at least be able to transplant everybody with HIV that is currently on the waiting list," says Segev, who has urged Congress to fix what he calls "a mistake in the law."
Segev and his allies have found supporters in Congress. A Senate bill lifting the transplant ban (S.330), sponsored by Senator Barbara Boxer (D-CA), won unanimous approval in June. Now, the House bill (H.R. 698) has passed its first major hurdle, winning unanimous approval from the Energy and Commerce Committee on 17 July.
"Our current organ transplant polices are outdated and do not reflect the most current research and clinical outcomes," said Representative Michael Burgess (R-TX), a co-sponsor, in a statement. Initially, Burgess said that he was "concerned" about the idea of lifting the ban, "but it does seem to be sound, science-based policy." He noted that surgeons are already able to do positive-to-positive transplants with donors and recipients infected with the hepatitis C virus, which is spread by means similar to those of HIV.
Lifting the HIV transplant ban would also be "good fiscal policy" because it could reduce treatment costs, Burgess said. For patients with HIV and kidney failure who get government-subsidized dialysis, for instance, a successful kidney transplant could save the government $500,000 per patient, says Kim Miller, policy officer for the HIV Medicine Association in Arlington, Virginia, one group backing the bill.
Several studies have suggested that positive-to-positive transplants work. A team of doctors in South Africa transplanted HIV-positive kidneys into four HIV-positive recipients in 2010; a year later the patients were still doing well. Another 2010 study published in The New England Journal of Medicinefollowed 150 HIV-positive kidney transplant recipients for 3 years, finding that most were successful. One big challenge, the study found, was determining how to balance antiretroviral drugs that the patients took to combat HIV with the immunosuppressive drugs meant to thwart organ rejection.
To address such problems, both the House and Senate bills would task the organ network with monitoring research on positive-to-positive transplants. The U.S. Department of Health and Human Services, which oversees the network, would use the findings to develop new healthcare standards for the transplants 2 years after the bill became law. Researchers say that lifting the ban could also ease studies that could help improve pre- and post-transplant treatments, donor selection criteria, and preventing HIV-infected organs from being transplanted into patients without the disease.
One difference between the House and Senate bills is that the Senate version makes it clear that surgeons who transplant HIV-infected organs would not be subject to criminal charges, as they are under the current law, if research shows that the transplants pose no health risks. That and other differences between the bills could be cleared up if the full House passes its version, allowing the two bodies to negotiate a final bill. The legislation's backers are optimistic that it will win final approval in the House later this year. The Obama administration has yet to take a formal position on the proposal.
Bill to lift ban on HIV organ donation passes House committee (and Senate too, see below)
Thursday July 18, 2013 LGBTweekly.com
WASHINGTON - The House Energy & Commerce Committee has approved the HIV Organ Policy Equity (HOPE) Act, H.R.698. The bipartisan bill sponsored by Rep. Lois Capps (D-CA) would lift a federal ban on the donation of HIV-positive organs to HIV-positive recipients, making it possible for researchers to study the safety of such procedures. The bill passed the Senate in June.
"The HOPE Act represents sound public health policy," said HRC legislative director Allison Herwitt. "The action by the House Energy & Commerce Committee is a major step forward in removing an outdated barrier which impedes access to lifesaving transplants for persons living with HIV and AIDS."
Today, more than 100,000 patients are actively waiting for life-saving organs and about 50,000 more are added annually. Permitting organs from HIV-positive donors to be used for transplant in HIV-infected patients with liver or kidney failure could save as many as 1,000 people each year. As organs from HIV-infected donors would only be transplanted to HIV-infected transplant candidates, the waiting time for HIV-infected people who accept HIV-infected organs would most certainly decrease, as would the general waiting list for uninfected people awaiting transplants.
The HOPE Act directs the Department of Health and Human Services and the Organ Procurement Transplant Network (OPTN) to develop and institute standards for research on HIV-positive organ transplantation and permits the Secretary to permit positive-to-positive transplantation if it is determined that the results of research warrant such a change. The Secretary would be required to direct OPTN to develop standards to ensure that positive-to-positive transplantation does not impact the safety of the organ transplantation network.
The Centers for Disease Control issued draft Public Health Service Guidelines in September of 2011 that recommended research in this area, but noted that federal law has blocked this important research from taking place in the United States.
The United Network for Organ Sharing, which manages the nation's organ transplant system, and over 40 other patient and medical advocacy organizations have endorsed the HOPE Act.
This week marks the third anniversary of the launch of the President's National HIV/AIDS Strategy, the country's first blueprint to address the decades-long epidemic. In recognition of that milestone the White House issued an Executive Order, establishing the HIV Care Continuum Initiative which directs federal agencies to prioritize addressing the continuum of HIV care by accelerating efforts and directing existing federal resources to increase HIV testing, services, and treatment, and to improve patient access to all three.
Estimating the Potential Pool of HIV-Infected Deceased Organ Donors in the United States - pdf attached
American Journal of Transplantation 2011
Link to full text:
Human immunodeficiency virus (HIV) is no longer a contraindication to transplantation. For HIV-infected patients, HIV-infected deceased donors (HIVDD) could attenuate the organ shortage and waitlist mortality. However, this practice would violate United States federal law. The goal of this study was to estimate the potential impact of legalizing transplantation of HIV-infected organs by quantifying the potential pool of HIVDD. Using Nationwide Inpatient Sample (NIS) data, HIV-infected deaths compatible with donation were enumerated. Using HIV Research Network (HIVRN) data, CD4 count, plasma HIV-1 RNA level, AIDS-defining illnesses and causes of death were examined in potential HIVDD. Using UNOS data, evaluated donors who later demonstrated unanticipated HIV infections were studied. From NIS, a yearly average of 534 (range: 481-652) potential HIVDD were identified, with 63 (range: 39-90) kidney-only, 221 (range: 182-255) liver-only and 250 (range: 182-342) multiorgan donors. From HIVRN, a yearly average of 494 (range: 441-533) potential HIVDD were identified. Additionally, a yearly average of 20 (range: 11-34) donors with unanticipated HIV infection were identified from UNOS. Deceased HIV-infected patients represent a potential of approximately 500-600 donors per year for HIV-infected transplant candidates. In the current era of HIV management, a legal ban on the use of these organs seems unwarranted and likely harmful.
Could HIV-Infected Organs Save Lives?
Release Date: 03/30/2011
Johns Hopkins researchers argue for reversing ban on transplanting infected organs and making them available to HIV-infected patients
If Congress reversed its ban on allowing people with HIV to be organ donors after their death, roughly 500 HIV-positive patients with kidney or liver failure each year could get transplants within months, rather than the years they currently wait on the list, new Johns Hopkins research suggests.
"If this legal ban were lifted, we could potentially provide organ transplants to every single HIV-infected transplant candidate on the waiting list," says Dorry L. Segev, M.D., Ph.D., an associate professor of surgery at the Johns Hopkins University School of Medicine and the study's senior author. "Instead of discarding the otherwise healthy organs of HIV-infected people when they die, those organs could be available for HIV-positive candidates."
Not only would HIV-positive transplant candidates get organs sooner if such transplants were legalized, Segev says, but by transplanting those patients and moving them off the waiting list, the time to transplant would be shorter for non-HIV-infected patients.
The ban on organ donation by HIV-positive patients is a relic of the 1980s, when it was still unclear what caused AIDS, at the time a devastating new epidemic sweeping the United States. Congress put the ban into the National Organ Transplant Act of 1984 and it has never been updated, despite the fact that HIV is no longer an immediate death sentence but a chronic disease managed with medication.
The number of HIV-positive patients receiving kidney or liver transplants - with non-HIV-infected organs - is on the rise as doctors become more comfortable with the idea, and patients are having good outcomes, Segev says. In 2009, more than 100 HIV-positive patients got new kidneys and 29 got new livers. HIV-infected patients may encounter accelerated rates of liver and kidney disease due in part to the toxic effects of antiretroviral therapy, the medications that keep HIV at bay.
Segev and his colleagues set out in their study, published early online in the American Journal of Transplantation, to estimate the number of people who die each year in the United States who are good potential organ donors except for that they are HIV-positive. They culled data from two main sources - the Nationwide Inpatient Study, which has information on in-hospital deaths of HIV-infected patients, and the HIV Research Network, a nationally representative registry of people with HIV. The team determined that the number of annual deaths with what are believed to be organs suitable for transplantation was approximately the same as estimated by each data source - an average of 534 each year between 2005 and 2008 in the Nationwide Inpatient Study and an average of 494 each year between 2000 and 2008 in the HIV Research Network.
While no transplants of HIV-infected organs into HIV-infected patients have been done in the United States because of the ban, Segev says doctors in South Africa have started doing this type of transplant with excellent results.
Segev suggests that, in transitioning to a system where HIV-infected donor organs can be transplanted into HIV-infected patients, doctors can call on the lessons and experience of transplanting hepatitis C patients with organs from people with the same disease. This practice, which has not always been the standard, has substantially shortened the waiting list for these recipients without significantly compromising patient or graft survival. The decision of whether or not to use these organs is not a legal one, but one made by the clinician.
Using HIV-infected organs is not without concerns. There are medical and safety issues that need to be addressed. Doctors need to make sure that the harvested organs are healthy enough for transplant and that there is minimal risk of infecting the recipient with a more aggressive strain of the virus. There is also a fear that an HIV-infected organ could accidentally be transplanted into an HIV-negative recipient. Segev says that hepatitis C-infected organs are clearly marked as such and similar protocols can be developed with HIV-infected organs.
"The same processes that are in place to protect people from getting an organ with hepatitis C accidentally could be put in place for HIV-infected organs," Segev says. "When you consider the alternative - a high risk of dying on the waiting list - then these small challenges are overshadowed by the large potential benefit."
Segev says eliminating the prohibition on HIV-infected organ donation would have immediate results. At first, he predicts, there would be more HIV-infected organs than people on the waiting list. Then, as doctors realized that their HIV-infected patients would no longer have to wait five-to-seven years for a transplant, Segev says he thinks more and more HIV-infected patients would sign up for the shortened list for an HIV-infected organ.
"The whole equation for seeking a transplant for someone with HIV and kidney or liver failure would change if this source of organs became available," he says. "We want the decisions taken out of the hands of Congress and put into the hands of clinicians."
This research was supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases.
Senate passes bill to allow research on organ transplants for HIV patients
By Ramsey Cox - 06/17/13 http://thehill.com
The Senate passed a bill Monday night that would establish safeguards and standards of quality for research of organ transplants for people infected with human immunodeficiency virus (HIV).
Sen. Barbara Boxer (D-Calif.) introduced the HIV Organ Policy Equity Act, S. 330, which would allow research on possible health risks for people with HIV receiving organs transplants from donors who also have HIV.
The bill also directs the secretary of Health and Human Services (HHS) to develop and publish guidelines for the conduct of research relating to transplantation of organs from HIV-infected donors.
Before the Senate passed the bill by unanimous consent, a committee-reported substitute amendment and an amendment from Sen. Chuck Grassley (R-Iowa) were added to the legislation.
Grassley's amendment clarifies that if research shows there are no health risks involved in the procedure, that it would no longer be a crime for people with HIV to donate organs.
"I applaud the Senate for moving to end this outdated ban on research into organ donations between HIV-positive individuals," Boxer said Monday. "This legislation offers hope for thousands of patients who are waiting for transplants by allowing scientists to research safe and effective ways to transplant these organs and save lives."
The bill now heads to the House, where Rep. Lois Capps (D-Calif.) introduced a companion measure, H.R. 698.
Senate Passes Bill Ending Ban On HIV-Positive Organ Donation Research
Posted by: Bridgette P. LaVictoire on June 18, 2013.
The HIV Organ Policy Equity Act (HOPE Act) passed late last night. The bill had bipartisan support, and its passage was praised by Senator Barbara Boxer (D-CA) and Senator Tom Coburn (R-OK). The legislation would lift "the federal ban on research into organ donations from HIV-positive donors to HIV-positive recipients."
Following the passage of the HOPE Act, Senator Boxer stated "I applaud the Senate for moving to end this outdated ban on research into organ donations between HIV-positive individuals. This legislation offers hope for thousands of patients who are waiting for transplants by allowing scientists to research safe and effective ways to transplant these organs and save lives."
She was joined in praising its passage by Senator Coburn, who is a medical doctor. Senator Coburn stated "The passage of the HOPE Act is an encouraging step forward for HIV-positive individuals who need organ transplants. By lifting these arcane federal regulations, we give hope by allowing doctors and scientists to explore potentially transformative research into organ donations between HIV-positive patients."
The bill was "sponsored by Senators Tammy Baldwin (D-WI), Rand Paul (R-KY), Richard Burr (R-NC), Michael Enzi (R-WY), Elizabeth Warren (D-MA), Mark Kirk (R-IL), Dianne Feinstein (D-CA), Mary Landrieu (D-LA), Brian Schatz (D-HI), Richard Blumenthal (D-CT), Roy Blunt (R-MO), Mark Pryor (D-AR) and Carl Levin (D-MI)."
The bill would, eventually, allow for the transplantation of HIV-positive organs into the bodies of those who already suffer from the disease. There are, currently, thousands of HIV-positive individuals who are in need of organ transplants, but the ban on researching the feasibility of the transplants is banned by federal law.
According to Senator Boxer's office, the HOPE Act would establish a standardized review process overseen by the Health and Human Services Secretary. HHS would "evaluate the process of medical research into the procedures." If they find that the research shows that it is possible to safely and successfully transplant organs from HIV-positive donors to HIV-positive recipients, then the HHS Secretary will be able to direct the Organ Procurement and Transplantation Network to set up procedures for these transplantations to occur.
The HOPE Act overturns the ban on HIV-positive organ donation and research first put into place as part of the Organ Transplant Amendments Act of 1988. The OTAA is now woefully out of date "thanks to advances in antiretroviral therapy."
Because of those therapies, HIV-positive individuals are living longer lives, and because they are living longer lives, they are faicing chronic conditions such as liver and kidney failure.
In the early days of HIV/AIDS, information regarding the disease was still being gathered, and a lot of misinformation was available. During that time, people thought that the disease could be passed through casual contact. For medical personnel, the disease, which is passed through bodily fluids, resulted in numerous changes in how they handled patient care including and especially around situations involving blood and saliva. Bans on blood donation by gay men, which are still in place in the United States, came into effect after several cases of people contracting the disease thanks to contaminated blood.
Boxer's office notes that "There are currently more than 100,000 patients on the active waiting list for organ transplants in the United States and about 50,000 people are added to the list each year - but fewer than 30,000 transplants are performed annually. Tragically, many patients die while waiting for a transplant." One study has pointed out that allowing organ transplants from HIV-positive donors to HIV-positive recipients would have the effect of increasing the donation pool by about 500 to 600 donors a year, saving hundreds of lives.
A long list of medical associations support the bill "including the American Medical Association, American Society of Transplant Surgeons, American Society of Transplantation, Association of Organ Procurement Organizations, American Academy of HIV Medicine, American Society for the Study of Liver Disease, the Human Rights Campaign, National Minority AIDS Council, HIV Medicine Association, National Coalition for LGBT Health, Infectious Diseases Society of America, Gay and Lesbian Medical Association, United Network for Organ Sharing, The AIDS Institute, amfAR (American Foundation for AIDS Research), Lambda Legal, the Treatment Access Group (TAG), and AIDS United."
Focus on passing the HOPE Act now shifts to the House where it has been supported by a bipartisan group headed up by Representatives Lois Capps (D-CA) and Andy Harris (R-MD).
Bill Reversing Ban on HIV Organ Donation Set For House Markup
July 17, 2013 CQ News
Two bipartisan health bills are slated to be marked up by the House Energy & Commerce Committee this week, including legislation similar to a measure that breezed through the Senate last month.
That bill (HR 698) would allow research on organ donation from individuals who are HIV+, reversing a decades-old ban and potentially paving the way for organs from HIV+ donors to be transplanted into patients who are also HIV+. The Senate passed companion legislation (S 330) by unanimous consent on June 17 that incorporated changes supported by House sponsor Lois Capps, D-Calif.
The bill appears poised to advance, given its track record in the Senate, which means it could join the relatively short list of health care accomplishments for the 113th Congress if no opposition emerges. Unlike most legislation related the 2010 health care law (PL 111-148, PL 111-52), the measure has a diverse group of supporters from both sides of the aisle.
"This is one of those issues that worked out very well because there was bipartisan interest in both houses", said Maryland Rep. Andy Harris, the lead Republican co-sponsor of the House bill. "That's why I believe it's going to succeed this week."
Under the organ donation bill, a 1988 provision (PL 100-607) that outlawed organ donations from HIV+ individuals would be repealed and the Health and Human Services Dept. would be directed to set up guidelines for researching organ transplantation from those donors. If a review of the research shows that the transplants are safe and effective, HHS would instruct the network that maintains the national organ-matching system to change the current standards.
Harris called it "a common sense bill that modernizes our policy toward donation by HIV+ donors to HIV+ recipients." He also said he hopes the measure can be considered under suspension of the rules, an expedited procedure that requires a two-thirds majority for passage.
"The process has been validated in other countries and it's about time we, you know, make use of those organs here in the United States," he said.
In a statement, Capps also said she was encouraged that the measure had been scheduled for markup and expressed hope that it would become law quickly.
"The HOPE Act is the result of bipartisan and bicameral collaboration and is critically important for transplant patients across the country," she said.
A New Push to Let H.I.V. Patients Accept Organs That Are Infected
David Ahntholz for The New York Times
Some health experts say H.I.V.-infected organs may be suitable for patients like David Aldridge, who is already infected.
NY Times By PAM BELLUCK
Published: April 11, 2011
David Aldridge of Los Angeles had a kidney transplant in 2006, but he will soon need another. Like many people living with H.I.V., he suffers from kidney damage, either from the virus or from the life-saving medications that keep it at bay.
Until recently, such patients did not receive transplants at all because doctors worried that their health was too compromised. Now they can get transplants, but organ-donor waiting lists are long. And for Mr. Aldridge, 45, and other H.I.V. patients, a potential source of kidneys and livers is off limits, because it is illegal to transplant organs from donors who test positive for the virus - even to others who test positive.
But federal health officials and other experts are calling for repeal of the provision that bans such transplants, a 23-year-old amendment to the National Organ Transplant Act.
"The clock is ticking more quickly for those who are H.I.V.-positive," said Dr. Dorry Segev, transplant surgery director of clinical research at Johns Hopkins and a co-author of a new study indicating that 500 to 600 H.I.V.-infected livers and kidneys would become available each year if the law were changed. "We have a huge organ shortage. Every H.I.V.-infected one we use is a new organ that takes one more person off the list."
The ban on transplanting organs from people with the virus that causes AIDS was passed at the height of the AIDS scare in 1988, when infection with the virus was considered a death sentence. But now many people with H.I.V. are living long enough to suffer kidney and liver problems, adding to the demand for organs.
This has led some health authorities to say that H.I.V.-infected organs should be available for transplant, primarily for patients infected with the virus but also potentially for some who are not.
The federal Centers for Disease Control and Prevention and other health agencies are about to issue new guidelines that will encourage a first step: research involving transplanting H.I.V.-positive organs into H.I.V.-positive people. That would require the transplant ban to be lifted.
"We would like to see as many safe transplants occurring as possible, and there's no reason why H.I.V.-positive recipients shouldn't get transplants and that H.I.V.-positive donors can't be used," said Dr. Matthew Kuehnert, who directs the C.D.C.'s Office of Blood, Organ and Other Tissue Safety.
"I could see someone saying: 'That's horrible. Why would you want to transplant H.I.V.?' "he said. "They don't understand. Anyone who understands transplant today, in the current era, understands the need."
The H.I.V. Medicine Association, a professional group, just issued a similar statement, calling for "changing federal law on H.I.V.-infected organ donation." Its chairwoman, Dr. Kathleen Squires, said her organization and other medical groups would lobby Congress this year.
Until recent years, H.I.V.-positive patients were not given transplants because of concerns that the virus could destabilize transplanted organs or that the immunosuppressive drugs used in transplants might make the virus more dangerous.
But a large clinical trial found that results in H.I.V.-positive recipients are "just as good as H.I.V.-negative patients, more or less," said the study's leader, Dr. Peter Stock, a transplant surgeon at University of California, San Francisco. "Our kidney patients do slightly worse than the general population of transplant patients, but better than kidney transplant patients over 65."
Last year, at least 179 H.I.V-positive people received kidneys or livers, up from 9 in 2000.
Allowing H.I.V.-positive organs to be used would create an additional supply when some 110,000 Americans are awaiting transplants. They often wait years, and sometimes are too sick when organs become available to benefit from them.
There are concerns, even among some supporters of changing the law.
"People I know in the gay community are very split on it," said Michael Bauer, 45, of Iowa City, who became H.I.V.-positive two years ago and will probably need a liver transplant in coming years. "There's the concept that having an H.I.V-positive donor could actually be more damaging. You could have a donor who has a tougher strain of H.I.V."
Doctors say this and other risks could probably be managed by screening out the sickest donors and recipients. And for patients like Mr. Bauer, the risks may be worth it.
"I can get slapped on a list for a healthy liver, but there's a whole slew of people ahead of me," he said. "I don't want to be excluded from options."
Others fear that H.I.V.-infected organs could be transplanted by mistake. While extremely rare, such errors have occurred.
In Chicago in 2007, four recipients were infected by organs from a single dead donor; the body had tested negative, but the test was administered too early, before the virus could be detected. In 2009 a kidney recipient in New York was infected from a living donor, who tested negative, then had unprotected sex and became infected in the 79 days before the transplant. That case prompted the federal disease centers to issue stricter testing recommendations this year, and Dr. Kuehnert said the new guidelines would address ways to make transplants even safer.
Not all the consequences of transplants involving H.I.V. patients are understood yet. Dr. Stock's patients, for example, were two to three times as likely as other recipients to begin rejecting their healthy donated kidneys. More immunosuppressive drugs helped them adjust, he said, but the donated kidneys may wear out sooner, necessitating additional transplants.
The only known transplants involving H.I.V-positive donors and recipients, conducted in South Africa, have so far been successful.
There, with H.I.V. widespread, Dr. Elmi Muller, a Cape Town surgeon, performed four transplants in 2008 - "instead of wasting these kidneys, throwing them literally in the bin," she said. After word got around, she said, some people questioned "whether it was the right thing to do."
Dr. Muller stopped while ethics committees reviewed the question, and she ultimately obtained approval. Of 10 patients she has transplanted, only one has experienced rejection problems. About 50 are on a waiting list.
In the United States, patients with hepatitis C, a disease many H.I.V-positive patients also have, are now living with organs from donors with hepatitis C.
In 2004, Illinois passed a law allowing transplant of H.I.V-positive organs, and "our hope was maybe other states will pick this up," said Dr. Michael Abecassis of Northwestern Memorial Hospital in Chicago. But federal transplant law supersedes the state one.
If such transplants are allowed, they will most likely start with clinical trials, and most organs will come from deceased donors; living donors are at risk for liver and kidney problems themselves. Most recipients would probably be H.I.V-positive because "we don't really know what would happen to someone with non-H.I.V. status," Dr. Abecassis said.
But some experts, including Dr. Segev and Dr. Kuehnert, say they can foresee such transplants even for H.I.V.-negative patients because contracting H.I.V. would be preferable to kidney or liver failure.
"I don't want to minimize living with H.I.V, but it is a medically treatable disease now," said Charlie Alexander, president of the United Network for Organ Sharing, which manages the country's organ transplant system. "In certain cases, I think it would be medically appropriate."
Mr. Aldridge, the Los Angeles patient, who has been H.I.V.-positive for 25 years, says he would certainly consider an infected kidney.
"There's a stigma about transplanting us to begin with, with some people saying why should an organ be quote unquote wasted on us," he said. "So if we can help each other it would make things much better for us. If I need a kidney transplant to survive, then so be it."