NY Med: New Frontiers in Medicine

The cutting-edge medicine on NY Med never fails to astonish me. If you haven’t been watching, NY Med is a medical documentary series that chronicles the experiences of physicians and nurses at my home hospital, New York Presbyterian. Seeing my colleagues in action brings about a feeling even greater than pride: admiration.

One subject in particular grabbed my attention: Gulf War Veteran John Rankl’s heart transplant – the first HIV heart transplant attempt in New England.

Back in 1986, when I graduated from medical school, an HIV diagnosis was an instant death sentence. Now in 2012, HIV-positive persons can live almost as long as everyone else. With the advent of new HIV medicines, HIV has become a treatable chronic medical condition, like diabetes or high blood pressure. There is even talk of a possible cure.

But life-threatening challenges still exist. HIV medications and complications can place patients at risk of organ failure, requiring an organ transplant. Waiting lists for organ transplants are usually long; however, an HIV-positive person will most likely wait even longer because many hospitals do not place HIV-positive people on transplant waiting lists as readily as they do for others. Hence, many of these patients die while waiting – not because of the virus itself, but because of the unfortunate position the virus has put them in.Across the country, a few hospitals are starting to transplant desperately needed organs – hearts, kidneys and livers – to HIV-positive individuals. Hospitals like New York Presbyterian, Mayo Clinic, and Cleveland Clinic have served as pioneers.

And the transplants work. A New England Journal of Medicine study revealed that the long-term survival rates for HIV-positive transplant recipients were comparable to the national average. They followed HIV-positive recipients of kidney transplants and found that despite the challenges of balancing the post-transplant and HIV medications, the patients lived.

Now, some medical experts are pushing the subject further. Instead of only allowing HIV-positive persons to serve as the recipients of organ donations, what if HIV-positive persons were able to donate organs as well? At least for HIV-positive recipients?

One roadblock to this concept is the National Organ Transplant Act (NOTA) of 1984, which provides federal guidelines for organ donation. It restricts various aspects of organ donation in order to keep the transplant network as safe and ethical as possible. (For example, by banning monetary compensation for organs, it prevents the exploitation of less-fortunate populations for their organs.)

NOTA also currently bans HIV-positive persons from being donors – a provision that was written in 1988, before the first HIV medications became available.

This past June, various medical groups set up a congressional briefing on Capitol Hill to address the desperate need for available organs for transplants. At that briefing, Dorry Segev, MD, PhD, an abdominal transplant surgeon at Johns Hopkins University, voiced his concerns: “Every year, hundreds of patients with HIV are dying while waiting for organ transplants. While at the same time, every year, we are throwing away hundreds of organs from patients who die while infected with HIV. Those organs could be used to save the lives of HIV-positive patients who die while on the waiting list.”

Segev’s research revealed that deceased HIV-infected patients represent a potential of approximately 500-600 appropriate donors per year for HIV-infected transplant candidates. This could substantially shorten the waiting time for patients like John Rankl. It would also shorten the waiting list for everyone – regardless of HIV status.

Rankl’s heart transplant at New York Presbyterian unfortunately failed because the heart was damaged. However, a month later, he received a successful heart transplant at Hartford Hospital. The hospital recently changed their policy on restricting HIV-positive heart donor recipients in order to allow Rankl to get a heart transplant. Currently, a year after his transplant, Rankl is 48 and in great health.

NY Med airs on ABC. Watch Part 1 of the finale tonight; Part 2 airs tomorrow August 22.

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