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Realizing HOPE: The Ethics of Organ Transplantation From HIV-Positive DonorsEthics of Organ Transplantation From HIV-Positive Donors

Christine M. Durand, MD; Dorry Segev, MD, PhD; and Jeremy Sugarman, MD, MPH, MA
[+] Article, Author, and Disclosure Information

This article was published at www.annals.org on 5 April 2016.


From Johns Hopkins University School of Medicine, Baltimore, Maryland.

Grant Support: By the NIH (grants K23CA177321-01A1 to C.M.D, 1K24DK101828-01 to D.S.) and the Johns Hopkins University Center for AIDS Research (P30AI094189).

Disclosures: Dr. Durand reports grants from and serves on the advisory board for Gilead Sciences, grants from and serves on the advisory board for Bristol-Myers Squibb, and serves as a scientific consultant for Merck Pharmaceuticals outside the submitted work. Dr. Sugarman reports grants from NIH during the conduct of the study; serves on the Bioethics Advisory Panel and Stem Cell Research Oversight Committee for Merck KGaA, is a member of the Ethics Advisory Panel for Quintiles, and has been a consultant on bioethics for Novartis outside the submitted work. Dr. Segev has disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-0560.

Requests for Single Reprints: Christine M. Durand, MD, Johns Hopkins University School of Medicine, 1830 East Monument Street, Room 450D, Baltimore, MD 21205; e-mail, christinedurand@jhmi.edu.

Current Author Addresses: Dr. Durand: Johns Hopkins University School of Medicine, 1830 East Monument Street, Room 450D, Baltimore, MD 21205.

Dr. Segev: Department of Surgery, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross 771B, Baltimore, MD 21205.

Dr. Sugarman: Berman Institute of Bioethics and Department of Medicine, The Johns Hopkins University, 1809 Ashland Avenue, Baltimore, MD 21205.

Author Contributions: Conception and design: C.M. Durand, D. Segev, J. Sugarman.

Analysis and interpretation of the data: C.M. Durand, D. Segev, J. Sugarman.

Drafting of the article: C.M. Durand, D. Segev.

Critical revision for important intellectual content: C.M. Durand, D. Segev, J. Sugarman.

Final approval of the article: C.M. Durand, C. Durand, D. Segev, J. Sugarman.

Obtaining of funding: C.M. Durand.

Collection and assembly of data: C.M. Durand, D. Segev.


Ann Intern Med. 2016;165(2):138-142. doi:10.7326/M16-0560
© 2016 American College of Physicians
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The HIV Organ Policy Equity (HOPE) Act now allows transplantation of organs from HIV-positive living and deceased donors to HIV-positive individuals with end-stage organ disease in the United States. Although clinical experience with such transplants is limited to a small number of deceased-donor kidney transplants from HIV-positive to HIV-positive persons in South Africa, unprecedented HIV-positive–to–HIV-positive liver transplantations and living-donor kidney transplantations are also now on the horizon. Initially, all HIV-positive–to–HIV-positive transplantations will occur under research protocols with safeguards and criteria mandated by the National Institutes of Health. Nevertheless, this historic change brings ethical opportunities and challenges. For HIV-positive individuals needing an organ transplant, issues of access, risk, and consent must be considered. For potential HIV-positive donors, there are additional ethical challenges of privacy, fairness, and the right to donate. Careful consideration of the ethical issues involved is critical to the safe and appropriate evaluation of this novel approach to transplantation.

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