SHOULD ALL HUMAN IMMUNODEFICIENCY VIRUS-INFECTED PATIENTS WITH END-STAGE RENAL-DISEASE BE EXCLUDED FROM TRANSPLANTATION - THE VIEWS OF US TRANSPLANT CENTERS

Background. Human immunodeficiency virus (HIV)infected patients have g enerally been excluded from transplantation. Recent advances in the ma nagement and prognosis of these patients suggest that this policy shou ld be reevaluated. Methods. To explore the current views of U.S. trans plant centers toward transplanting asymptomatic HIV-infected patients with end-stage renal disease, a written survey was mailed to the direc tors of transplantation at all 248 renal transplant centers in the Uni ted States. Results. All 148 responding centers said they require HIV testing of prospective kidney recipients, and 84% of these centers wou ld not transplant an individual who refuses HIV testing. The vast majo rity of responding centers would not transplant a kidney from a cadave ric (88%) or a living donor (91%) into an asymptomatic HIV-infected pa tient who is otherwise a good candidate for transplantation. Among the few centers that would consider transplanting an HIV-infected patient , not a single cen ter had performed such a transplant in the year pri ori to the survey. Most centers fear that transplantation in the face of HIV infection would be harmful to the individual, and some believe that it would be a waste of precious organs. Conclusions. The great ma jority of U.S. renal transplant centers will not transplant kidneys to HIV-infected patients with end-stage renal disease, even if their inf ection is asymptomatic. However, advances in the management of HIV inf ection and a review of relevant ethical issues suggest that this appro ach should be reconsidered.