Illinois becomes first state to allow HIV-infected people donate organs to others with HIV.

Illinois has become the first state to allow HIV-infected people to donate their organs to others also infected with HIV. Upon signing the legislation on July 15, Governor Rod Blagojevich emphasized the law will help people with HIV "live longer, healthier and more productive lives."

The new law - House Bill 3857 - took effect immediately but cannot be implemented until the US Department of Health and Human Services (HHS) changes its policy against such donations. The current policy, which hasn't been revised since June of 1992, prohibits the transplantation of organs from donors who are confirmed reactive for HIV.

Patrick Lynch, MD, a hepatologist at Northwestern Memorial Hospital in Chicago, who helped draft the new law pointed out the organs will be able to prolong the lives of patients who already have HIV.

"When those laws were originally put on the books, they made sense. HIV was, unfortunately, a death sentence back then," Lynch said, according to the Associated Press. "That doesn't make sense anymore."

"As we learn more about HIV and AIDS and the medications used to manage the disease, we need to be willing to explore new ways to treat and care for those with the devastating illness," Blagojevich said.

The language in the bill allowing HIV patients to donate organs reads: "It is not a violation [of this section] for a person to perform a solid organ transplant of an organ from an HIV infected donor to a person who has tested positive for exposure to HIV or any other identified causative agent of AIDS and who is in an immediate threat of death unless the transplant is performed. A tissue bank that provides an organ from an HIV infected donor under this subsection (c-5) may not be criminally or civilly liable for the furnishing of that organ under this subsection (c-5)."

The law defines solid organ transplant as "including, but not limited to, the liver, kidney, pancreas, lungs, or heart." Bone marrow transplants and blood transfusion are specifically excluded from the law.

An HIV infected donor applies to "a deceased donor who was infected with HIV or a living donor known to be infected with HIV and who is willing to donate a part or all of one or more of his or her organs."

The HIV donor provision is contained in an amendment to House Bill 3857 which calls for the Illinois Department of Health to establish a registry of all sperm banks and tissue banks operating in the state. The law applies to "any person, hospital, clinic, corporation, partnership, or other legal entity that operates a sperm bank or tissue bank" in the state.

The law also requires all donors of semen for purposes of artificial insemination, or donors of corneas, bones, organs, or other human tissue to be tested for evidence of exposure to HIV and any other causative agency of AIDS. It also seems to exclude HIV positive people from donating semen, corneas, bones or other tissue although the language is ambiguous.

The language reads: "Except as otherwise provided in subsection (c-5), no person may intentionally, knowingly, recklessly, or negligently use the semen, corneas, bones, organs, or other human tissue of a donor who has tested positive for exposure to HIV or any other identified causative agent of AIDS. Violation of this subsection shall be a Class 4 felony."

The Organ Procurement and Transplant Network (OPTN)/ UNOS policies on considering HIV-infected patients or AIDS patients as potential donors and/or potential organ recipients is clear:

The HHS' OPTN Final Rule requires the OPTN to adopt and use standards for preventing the acquisition of organs from individuals infected with the HIV virus.

The OPTN/UNOS policy 4.1.2 reads: "Organ Sharing: UNOS members shall not knowingly participate in the transplantation or sharing of organs from donors who are confirmed reactive for HIV-Ab by an FDA licensed screening test unless subsequent confirmation testing unequivocally indicates that the original test's results were falsely positive for HIV-Ab."

The Centers for Disease Control and Prevention (CDC) "Guidelines for Preventing Transmission of Human Immunodeficiency Virus Through Transplantation of Human Tissue and Organs" - published May 20, 1994 - presents very detailed information and recommendations to prevent the transmission of HIV.

However, the 19-page document contains one paragraph that might provide the basis for changing the HHS policy.

Under a section on Donor Exclusion Criteria, the CDC noted: "Regardless of their HIV antibody test results, persons who meet any of the criteria [listed below] should be excluded from donation of organs or tissues unless the risk to the recipient of not performing the transplant is deemed to be greater than the risk of HIV transmission and disease (e.g., emergent, life-threatening illness requiring transplantation when no other organs/tissues are available and no other lifesaving therapies exist). In such a case, informed consent regarding the possibility of HIV transmission should be obtained from the recipient."

A complete copy of the Illinois law can be found at www.legis.state.il.us/legislation/93/hb/09300hb3857ham001.htm.

The OPTN/UNOS policy can be found at: www.unos.org/PoliciesandBylaws/policies/docs/policy_16.doc.

The CDC guidelines can be found at: www.cdc.gov/mmwr/preview/mmwrhtml/00031670.htm.