Friday, July 16, 2004

Sounds Great in Theory ...

This New York Times story on state initiatives to permit organ donations by HIV-positive individuals has me feeling perplexed; it sounds great at first blush, but on further consideration one has to wonder just how good an idea it really is.

Gov. Rod R. Blagojevich of Illinois signed a bill on Thursday allowing people who are H.I.V. positive to donate organs to others infected with H.I.V., a provision that he called the first of its kind in the United States.

State Representative Larry McKeon, the Chicago Democrat who wrote the bill, said the decision was certain to save the lives of people with H.I.V., the virus that causes AIDS, who are waiting for liver transplants but have always been barred, as is everyone, from receiving donations from those with the virus. Mr. McKeon, 60, is himself H.I.V. positive and said he had been for 15 years or more. He said he was proud now to check off the box on the back of his Illinois driver's license, agreeing to become something he had not been allowed to be: an organ donor.

Some doctors and advocates for people with AIDS said the move by Illinois was certain to prompt similar actions in other states - and perhaps even a national shift in the rules that bar people with H.I.V. from becoming donors, despite what these advocates describe as the perfectly safe option of donating organs to other infected people. But federal authorities raised questions about the Illinois law, and said that any move to allow H.I.V.-positive organ donors would violate provisions of the National Organ Transplant Act of 1984.

"The federal law specifically states that no organs can be donated by those with H.I.V.," said Kevin Ropp, a spokesman for the Health Resources and Services Administration, part of the Department of Health and Human Services. "The purpose was to prevent the spread of H.I.V. and AIDS."

Lawyers for Mr. Blagojevich, however, said they had interpreted the federal organ donation procedures differently and believed Illinois could proceed as planned with its law, which went into effect as soon as it was signed on Thursday, said Abby Ottenhoff, a spokeswoman for the governor. The lawyers acknowledged that Illinois doctors may need to seek certain variances to the regulations, but said that exceptions had been granted in the past, and that this was a logical next step.

"We're hopeful that by removing an obstacle in Illinois, they'll be able to make change at the federal level," Ms. Ottenhoff said.
Hmm, here we see the states' rights issue arising yet again, except this time it's a state which is trying to force the federal government's hand. But that isn't really what I'm most interested in. The following is:
In Springfield, Representative McKeon won his fight to pass the organ donation legislation with little trouble. It passed the House, which is dominated by Democrats, 95 to 22, and the Senate, also dominated by Democrats, with 55 in favor, 2 opposed and 1 "present." The legislation applies to organ donors with H.I.V. or full-blown AIDS, and to those who are living at the time of the donation as well as to those who have just died. It applies only to organ donation, not blood donations or bone marrow transplants.

The most serious questions Mr. McKeon said he received were related to safety. Some colleagues wondered: How can a doctor ensure that an H.I.V.-negative patient does not accidentally receive the organ of someone with H.I.V.? And can there be any additional danger to those who already have HIV from a different strain of it?

"There are reasonable fears," Mr. McKeon acknowledged. "But my position and the position of the medical people is that this doesn't add any increased risk."
I'm afraid I can't share Mr. McKeon's complacent assumption that organ transplants between HIV-infected people don't "add any risk." This could very well open the floodgates to a lot more cross-pollination of HIV strains, and with it the emergence of super-resistant variants that combination therapy would do little to contain. I do think this should be allowed to go ahead, but I also think it has to be watched closely. It's clear why the HIV-positive Representative McKeon can see no possible downside to this initiative, but HIV is a public health issue, and the rest of us can't really afford to indulge those of his persuasion if their stance is undermined by the evidence.