Until the development of liver transplantation, end stage renal disease was considered a death sentence (Iredale). Currently, four thousand liver transplants are preformed each year (“Liver Transplantation”). While this is clearly an improvement over the alternative, it still leaves many patients without a viable option. At any given time there are more than four times the number of pople on the list as there are who get livers. There are simply too few livers to save everyone. I have a recommendation that, while it will not completely solve that problem, will add to the number of donor livers available. I think that adding otherwise healthy HIV-positive donors to the list will increase the numbers of lives saved by liver transplantation.
While the fact that four thousand liver transplants are performed each year is an impressive statistic, there are other statistics that aren’t so reassuring. The liver transplant list is made up of 17,000 would be recipients. The length of the list grows yearly. And of those 17,000 on the waiting list, 1500 die while waiting for a liver each year (“More About Organ Donation”).
Without a transplant, people with end stage renal failure will die. And those who survive are often very ill, clinging to life and suffering. The symptoms they experience are “worse than many advanced cancers (Iredale).” The quality of life for these patients is sub par to say the least. If a liver is not available, the only treatment possible is comfort care, and even that has its challenges. The liver is where drugs are processed. If the patient has liver failure the medications will not be processed as they would in a typical patient (Iredale).
Given the situation of the thousands of people on the transplant list, adding otherwise healthy HIV-positive donors to the list will save lives. HIV no longer carries with it a death sentence, nor does it mean illness and suffering. HIV patients can live asymptomatically for decades. In fact, as long as patients with HIV are treated they have “a life expectancy approaching that of the general population (Samji).
This is not to say that my recommendation is without risks. HIV is still a potentially fatal illness. While most HIV-positive patients with treatment are asymptomatic, this is not a guarantee. What it comes down to is a cost benefit situation.
As noted earlier, People in end stage liver disease will die without a liver transplant. That is a fact. It may not happen immediately, but if it does not, the quality of life leading up to it is miserable. A new liver in most cases alleviates that suffering. The comparison of being sick and on the brink of death versus having a new liver with HIV but being symptom free seems like an easy choice for me. Yes, there is a possibility that HIV will lead to AIDS and the recipient will die. But at the very least the recipient will gain some time that they would otherwise not have had.
Also, research says that the average life expectancy for and HIV-positive patient is 75 years old (Nakagawa). The question should be, does it make sense to accept a liver from an HIV-positive donor if it means a longer and improved quality of life. What makes the answer seem easy to me is, that if you are on the top of the transplant list, you are the sickest of the sick. The decision on who gets a liver is determined by what is called the Model for End-Stage Liver Disease (MELD). The MELD takes into consideration all of the patients signs and symptoms and determine who is the sickest, and they go to the top of the list.
My point is, that if you are on the top of the list you don’t have much time left. It seems to me, accepting a liver from an HIV-positive donor is the most logical decision. Allowing HIV-positive donors live or otherwise could save lives. There may not be large amounts of HIV positive donors, but even if only one person’s life is saved, I believe that it would be worth it.
Works Cited
Iredale, John. “End-Stage Chronic Liver Disease: Time to Define a Good Death.” Hepatology. June2008.
“Liver Transplantation.” Transplant Surgery. PennState Hershy. Nd. Web. 30Apr2014.
“More About Organ Donation.” American Liver Foundation. American Liver Foundation. 29Oct2013. Web. 1May2014
Nakagawa, Fumiyo et al. “Projected Life Expectancy of People with HIV According to Timing of Diagnosis.” AIDS. 26.3(2012): 335-43. Web. 4May2014.
Samji, Hasina et al. “Closing the Gap: Increases in Life Expectancy Among Treated HIV-positive Individuals in the United States and Canada.” PLOS ONE. 8.12(2013). Open Access. Web. 30Apr2014.