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An Exception to the Rule or a Rule for the Exception? The Potential of Using HIV-Positive Donors in Canada

Wright, Alissa J. MD; Rose, Caren PhD; Toews, Maeghan JD, LLM; Paquet, Michel MD; Corsilli, Daniel MD; Le Cailhier, Jean-François MD, PhD; Gill, John S. MD

doi: 10.1097/TP.0000000000001630
In View: Around the World

Abstract: Selected human immunodeficiency virus (HIV)-infected patients with end organ failure can safely receive an organ transplant from an HIV uninfected donor. Recent demonstration of the short term safety of organ transplantation between HIV-infected persons prompted a change in US American law to allow such transplantations. Prompted by the recent completion of the first organ transplantation between HIV-infected persons in Canada, we review Canadian law regarding the use of organs from HIV-infected donors, estimate the number of potential HIV-infected donors in Canada, and critically review considerations related to advancing organ transplantation from HIV-infected donors in Canada. Existing legislation allows organ transplantation from an HIV-infected donor under exceptional medical circumstances and therefore no change in legislation is required to increase utilization of organs from HIV-infected donors for transplantation in Canada. Among 335,793 hospital deaths between 2005 and 2009 in Canadian provinces excluding Quebec, 39 potential HIV-infected donors were identified. The actual number of HIV potential donors is estimated to be approximately 60% lower (3-5 potential donor per year), if the absence of viremia is required for transplantation. Although offering all Canadians the opportunity to donate organs is a laudable goal, further research to understand the need for HIV-positive donors and the willingness of HIV-positive recipients to accept organs from HIV-positive donors is needed to inform future policy regarding organ donation from HIV-infected persons in Canada.

1 Division of Infectious Disease, University of British Columbia, Vancouver, British Columbia, Canada.

2 Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.

3 Health Law Institute, Faculty of Law, University of Alberta, Edmonton, Canada.

4 Département de Medicine, Centre Hospitalier Universitaire de Montréal, Montreal, Canada.

5 Research Centre of Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada.

6 Montreal Cancer Institute, Montreal, Quebec, Canada.

7 Nephrology Division, CHUM and Department of Medicine, Université de Montréal, Montreal, Quebec, Canada.

8 Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.

Received 28 November 2016. Revision received 30 November 2016.

Accepted 10 December 2016.

The authors received no specific funding for this paper. J.G. is funded by a Foundation Grant from The Canadian Institutes of Health Research. M.T. is jointly funded by Canadian Blood Services and the Canadian National Transplant Research Program.

A.J.W. has previously received educational support from a combined University of British Columbia-Pfizer and Sunovion Pharmaceuticals grant. She has also received honoraria for speaking at a conference from Astellas and participated on an advisory board for Merck. J.G. has served as a consultant and received grant support from Astellas, Canada and served as a consultant for Alexion, Canada.

All authors contributed to the design of this study, the writing of this article and the review of the statistics, legal commentary and case information. C.R. performed the statistical analysis. M.T. provided expert legal commentary.

Correspondence: John S. Gill, MD, Division of Nephrology, University of British Columbia Providence Building, St. Paul’s Hospital, Ward 6a 1081 Burrard Street, Vancouver B.C., Canada V6Z 604-806-8970 1Y6. (jgill@providencehealth.bc.ca).

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