Ethical and scientific issues surrounding solid organ transplantation in HIV-positive patients: Absence of evidence is not evidence of absence

• Published in: The Canadian journal of infectious diseases & medical microbiology 2006-01, Vol.17 (1), p.15-18
• Main Authors: Christie, Timothy, Jiwani, Bashir, Asrat, Getnet, Montessori, Valentina, Mathias, Richard, Montaner, Julio
• Format: Article
• Language: English
• ISSN: 1712-9532; 1918-1493
• DOI: 10.1155/2006/286301

End-stage liver disease is emerging as a leading cause of death among HIV-positive patients. Historically, an HIV diagnosis was a contraindication for a liver transplant; however, because of the efficacy of highly active antiretroviral therapy (HAART), HIV-positive patients have one-year, two-year, and three-year post-transplantation survival rates similar to that of HIV-negative patients. Based on this evidence, HIV-positive patients are now considered eligible for transplantation. However, newly emerging guidelines include the stipulation that HIV-positive patients must be on HAART to be placed on a waiting list for transplantation. The purpose of the present paper is to evaluate the scientific and ethical probity of requiring HIV-positive patients to be on HAART as a condition for being on a liver transplant waiting list. It is argued that the emphasis should be placed on the probability of post-transplantation HAART tolerance, and that concerns about pretransplantation HAART tolerance are of secondary importance.