Obama Signs HOPE Act, Opens Door For HIV Positive Organ Donation, Research

organ transplant
Before the HOPE Act, HIV-positive organs were discarded immediately. Image courtesy of Shutterstock

President Obama signed the HIV Organ Policy Equity Act (HOPE) on Thursday, paving the way for researchers at the Department of Health and Human Services (HHS) to begin looking into the possibility of organ transplants between people who are infected with the human immunodeficiency virus (HIV). Before the act was passed, using the organs of HIV positive people was prohibited and any organ from an infected person had to be thrown away.

Even research into the effectiveness of HIV positive organ transplants had been banned. Though HIV positive patients could receive organ transplants from HIV negative donors, there could be no organ transplants between HIV patients. Now, public health advocates are lauding the passage of the HOPE Act, as having the potential to save many lives.

“Once research in this area opens up it is possible that we can use these organs in transplants for people who have been infected with HIV,” Robert Walsh, director of the Division of Transplantation at the Health Resources and Services Administration (HRSA), told TIME. “It could potentially provide a new source of organs for people who are HIV positive.”

The HOPE Act will remove some provisions of the National Organ Transplant Act (NOTA), which was passed in 1984, sponsored by Rep. Al Gore and Sen. Orrin Hatch. NOTA, which was amended in 1988 and 1990, outlawed selling human organs and established the Task Force on Organ Transplantation.

Writing for the Center for American Progress earlier this year, Andrew Cray, a health policy consultant, pointed out several reasons why passing the HOPE Act would be a positive step in organ transplant legislation. The HOPE Act would, Cray writes, “replace discriminatory stereotypes with data-driven science.” In the years since NOTA’s passage there have been significant medical advances for both organ transplantation and the prevention of virus transmission. Cray also notes that individuals with other infectious diseases like hepatitis C are permitted to donate organs to other hepatitis C patients, and there should no longer be a bias against HIV patients.

In South Africa, doctors have already tested and proved the efficacy of HIV positive organ transplants to other HIV patients. Dr. Elmi Muller is a surgeon from the University of Cape Town who has pioneered 26 HIV-positve-to-positive kidney transplants since 2008. Muller hoped to treat HIV patients with failing kidneys, because in South Africa, such patients are not very likely to receive dialysis. “I felt that where these patients didn’t have much option, there was not much to lose,” Muller told Nature.

“In resource-limited countries, places on dialysis programmes are severely restricted; HIV-infected patients, like many others with co-morbidity, are often denied treatment." Muller and Dr. Delawir Kahn of the Groote Schuur Hospital write in the South African Medical Journal. "Kidneys (and other organs) from HIV-infected deceased donors are discarded.” 

The authors go on to state that HIV positive transplants to HIV infected patients are “now a viable alternative to chronic dialysis or transplantation of HIV-negative donor kidneys.” However, Muller told Nature that significant research is still needed to ensure that positive-to-positive transplants are 100 percent safe. One safety concern is that a patient may be “superinfected” with a second strain of the HIV virus from a donated organ. Another issue is that patients must take both antiretroviral drugs and post-transplant drugs to prevent organ rejection, which could potentially cause problems.

However, the passage of the act signals a new era in the U.S. for HIV positive patients waiting for organ donations. “The decades-old policy is antiquated,” Andrew Levario, a senior public policy advocate at the Human Rights campaign, told TIME. “It hasn’t kept pace with where science is. This is a win-win for everyone.”

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