HIV Positive Organ Transplants
HIV Positive Organ Transplants
HIV Positive Organ Transplants: The Ethics of How HIV Patients Can Save Lives
By Eileen Cohn
Less than 40 years ago, being diagnosed with the Human Immunodeficiency Virus (HIV) was a death sentence, as there was no treatment for the virus. Most people who lived through the HIV/AIDS epidemic of the 1980s never would have guessed that people with HIV would one day be able to save lives by donating their organs. In 2013, a law that prohibited research on transplants between HIV patients was overturned. There are many benefits to HIV positive organ transplants, as they take HIV positive patients off the general waiting list for organs. This means that both patients who are HIV negative and HIV positive will be able to receive organs at a faster pace. Since around 20 people die each day while waiting for an organ transplant, this is extremely beneficial. Additionally, there are many treatments for HIV that those given an HIV infected organ can be offered, and HIV patients often live to the age of 60 or 70. However, one must consider the ethical complications caused by such an operation. Is it beneficent to transplant HIV positive organs into HIV patients? Is it fair that there is a separate waiting list for HIV positive patients? Are there ways that a patient’s autonomy could be violated, through coercion, in relation to this process? In the future, could those who do not have HIV receive HIV positive organs? There are multiple risks, benefits, and ethical considerations that must be taken into account when discussing HIV positive organ transplants. Despite this, it is undeniable that this operation is a cutting-edge innovation that will be able to save the lives of an incredible number of people.
Table of Contents
- Organ Transplants and Donation
- The Human Immunodeficiency Virus
- Ethics of HIV Positive Organ Transplants: Risks and Benefits
- Nonmaleficence vs. Beneficence
- Fairness and Autonomy
Within the next twenty-four hours, twenty people will die while waiting on the organ transplant waiting list, and 144 people will be added to this list. Moreover, there are more than 75,000 people currently waiting to receive an organ transplant. In addition to these 75,000, there are 40,000 people who need an organ transplant, but cannot receive one. There are multiple reasons why a person may not be able to receive a transplant, which I will discuss later (Data). An organ transplant is when one person donates one or more of their organs to one person or multiple people. In the past, because of certain legislation and the stigma around the Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS), people who had HIV had a very difficult time receiving organ transplants, since the procedure was completely illegal.
Even though HIV patients are now allowed to receive HIV positive organs, there are many ethical matters to consider in relation to this operation. How can one properly weigh the risk and benefits in this situation, and which outweighs the other? Is this operation beneficent, or does it violate a doctor’s oath to do no harm? Will autonomy be violated in the process of this procedure? How was the legislation surrounding HIV positive organ transplants unjust in the past, and what is unjust about the current legislation? Are the people who are allowed to receive certain types of organs and the process by which they do so fair? Organ transplantation is an incredibly important procedure, even for those who do not need to receive an organ. Almost everyone is healthy enough to become an organ donor, but only 540 out of 1000 people are registered organ donors, and a mere three in 1000 people will die in a way that allows them to donate their organs (Organ Donation Statistics). For this reason, it is of extreme importance that those who do have the ability to become an organ donor do so, as this allows for that person to donate their organs if they pass away in the right conditions. Even if a person cannot be an organ donor or does not need an organ transplant, they or someone they know might. Organ transplantation is something that affects everyone, including HIV patients, either directly or indirectly.
The two organs that HIV patients most commonly need to receive are kidneys and livers. HIV affects these organs most out of all of the organs in the body, for reasons that I will elaborate on at a later point. Unfortunately, the kidney is the organ that usually has the longest wait time, as well as being the organ that HIV damages the most. A person can wait as long as five to ten years to receive the organ. A person waiting for a liver transplant does not usually have to wait as long, as most liver transplants occur within 321 days (about eleven months) after a person becomes eligible for a transplant. (Understanding the Organ Transplant Waiting List). Upon considering this information, one begins to wonder how the system of organ donation can be improved for everyone, especially HIV patients. In this paper, I will discuss how organ transplantation and HIV patients are becoming increasingly related. I will consider what the risks, benefits, and ethics of the recently legalized operations involving organ transplants from HIV positive patients to other HIV positive patients are, and how these will affect our society both in the long and short term.
Organ Transplants and Donation
I will first go through some of the specifics of organ transplantation of both HIV negative and positive organs, before proceeding to information about HIV and the ethics of HIV positive organ transplants. One must go through multiple steps to become eligible to receive an organ donation. A person must first get a referral by their doctor for an organ transplant, since the doctor will have examined the patient and certified that the organ is necessary. The prospective organ recipient must then learn about finances related to the operation, recovery after the procedure, and other related information. The third step in the process of becoming eligible for an organ transplant is choosing a transplant center (sometimes a person’s doctor might recommend one to them). This is where the operation will take place when the time for the organ transplant comes, and the person should make an evaluation appointment with their transplant center. This will give them a chance to get to know the transplant team, who are the people that will be helping them with the organ transplant if they are approved. After this evaluation appointment, the transplant team will then determine whether or not the person is a good candidate for organ transplantation and notify them within ten days (The Organ Transplant Process).
Another important part of the organ donation process is the evaluation of donors. In the case of donation after death, which is when a person’s organs are donated after they have died, a person is checked to see if they have any infectious diseases. A person might not be able to donate an organ if the organ is damaged, either by an accident, drinking, smoking, or for another reason. If an organ has been sustained for too long on a ventilator, it might not have the ability to be donated, as human organs are not meant to be sustained on artificial life support. There are other qualification that HIV positive donors must meet. They must have their viral load evaluated. A viral load is essentially how many CD4 cells (cells infected by HIV) there are per milliliter of a person’s blood. This determines whether or not the HIV patient is able to donate organs, as the viral load of an HIV patient must be undetectable for them to be allowed to donate their organs. It is important to note that an undetectable viral load does not mean that a person is cured of HIV. An undetectable viral load is qualified as having less than fifty CD4 cells per milliliter of blood. After this evaluation is done, organ donors and previously evaluated organ recipients can be matched based on multiple factors. How long the recipient has been waiting for an organ, what the blood and tissue types of the donor and recipient are, and how long the recipient can wait for the organ are all things that are taken into consideration when transplant centers evaluate who should receive an available organ.
Another aspect of organ donation is the distance between the hospital where the organ donor passed away and the location of the organ recipient. Different organs can only last for certain times outside of the body, so if the distance is too great, the organ transplant cannot occur. A kidney can last from twenty-four to thirty-six hours, and a liver can last from eight to twelve hours. By comparison, these time periods are actually quite long. Other organs, like the heart and lungs, can only last four to six hours hours outside the body (Matching Donors and Recipients). There are currently two waiting lists that HIV patients can be listed on, while there is one that HIV negative patients can be listed on. This fact is tied in with the ethical values that I have considered, and I will discuss it at a later point. HIV patients can wait for HIV positive and negative organs, while patients who do not have HIV must wait for HIV negative organs, possibly never receiving the organ they need. However, to delve into the subject material of HIV positive organ transplants, one must first understand HIV and how it functions.
The Human Immunodeficiency Virus
When the Human Immunodeficiency Virus (HIV) invades the body, it attacks and takes complete control over the nuclei of CD4 cells (also called T-helper cells). These cells are incredibly important to our immune system, and they are crucial to fighting off disease and infection in the human body (How HIV Infects the Body and the Lifecycle of HIV). HIV can be transmitted sexually, through contaminated needles (blood transfusions or the injection of drugs), during pregnancy, during childbirth, or through breastfeeding (HIV/AIDS Overview).
HIV, through affecting the cells of the kidney, can cause kidney inflammation, which can eventually lead to kidney failure. Some HIV medication can also cause kidney problems, and doctors are careful to regulate how an HIV patient’s kidneys are handling treatment. Additionally, HIV can cause liver disease by infecting the cells of the liver with the virus. (HIV and Kidney Disease) HIV medication is known as highly active antiretroviral therapy (HAART). There are multiple types of HIV medication, and they stop HIV from turning into AIDS. These medications do this by blocking the formation of enzymes that are necessary for the HIV virus to replicate itself, blocking HIV from entering CD4 cells, and damaging proteins that allow HIV to enter CD4 cells. It is incredibly important that all HIV patients adhere to their drug regiment, as AIDS, which develops from untreated HIV, is lethal. (HIV Treatment).
The history of HIV starts sometime around 1920, which is when humans first contracted the HIV virus. The exact date is uncertain, since the first documented case of HIV was in 1981. This contamination took place in Africa, where people would use primates infected with the Simian Immunodeficiency Virus (SIV) as a food source. SIV was transferred to humans through contact with the infected blood of these primates. The effects of SIV on primates are incredibly similar to the effects of HIV on a human (Where did HIV come from?). Throughout the years leading up to the 1980s, HIV became an increasingly larger problem. By the time an effective treatment for HIV was released to the public in 1995, AIDS is one of the leading causes of death in America (A Timeline of HIV and AIDS). In 1984, the The National Organ Transplant Act (NOTA) created a set of rules and regulations pertaining to organ donation and transplants. Around this time period, many insurance companies denied financial assistance to HIV patients who need to receive an organ transplant. In 1988, NOTA was amended so that neither research surrounding HIV positive organ transplants nor the transplants themselves were allowed in the U.S. In 2013, twenty-five years later, NOTA was amended again, but this time to allow HIV positive organ transplants. Many hospitals are currently using this opportunity to save lives (Medical and Transplant Information).
Nowadays, people with HIV can live for forty to fifty more years after their diagnosis. We now have the ability to guarantee that HIV does not turn into AIDS. Those diagnosed with HIV around the age of twenty, which is the average diagnosis age, can live for almost the same amount of time as an average human lifespan (until the age of sixty or seventy). When HIV first emerged in America during the 1980s, this was not so. At that point in time, HIV was a death sentence, and a diagnosis meant that one had, at most, two years left to live. There was great fear surrounding the HIV/AIDS crisis that started in California. It was not yet known how HIV spread from person, nor was it known how a person could contract it. Additionally, HIV was a disease that, when it first emerged in the U.S., primarily affected gay men. Because of the lack of knowledge and understanding for the Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) community, this was one cause of homophobia. The stigma around HIV has become less of a problem only recently, since medical professionals have been able to find treatments and learn much more about HIV through research. However, there is still a ways to go in terms of how people think about HIV and those affected by it. HIV positive organ transplants are a large part of this movement forward, as they are changing the way both HIV patients, medical professionals, and the general population think about organ transplants and the value of a human life.
Ethics of HIV Positive Organ Transplants: Risks and Benefits
There are multiple risks and benefits involved in the transplant of HIV positive organs. One risk is that hospital errors have occurred, and might again. In one hospital, five people who were HIV negative received HIV positive organs because of a communication mistake within the facility. Although all five people survived and were able to live with HIV, we know so little about HIV positive organ transplants into HIV negative people that other mistakes might be lethal. Even if they are not, infecting an HIV negative person with HIV without their consent is extremely controversial, and if it happens again, might cause legislation to be passed which more tightly regulates HIV positive organ transplants. Mgbako et al. states that “The potential to harm transplant recipients through HIV transmission nonetheless remains a fundamental concern. Infecting an HIV+ recipient with a new strain of HIV could lead to uncontrolled viral replication, immune dysregulation, and opportunistic infections.” This quote signifies the lack of knowledge about HIV positive organ transplants among the medical community. Since most medical professionals, even if they are well-educated, well-informed, and have performed excellently in their career, have very little experience with HIV positive organ transplants through no fault of their own, this procedure must be regarded with extreme caution.
On the other hand, I have chosen to observe this uncertainty in a positive light. Because HIV positive transplants are only just beginning, we have a completely new opportunity to save the lives of so many who might have passed away if these transplants had not been legalized. This is one of the multiple benefits of HIV positive organ transplants. Another benefit of these transplants is that HIV patients will be able to receive transplants, allowing those with HIV to live longer and healthier lives. Until about fifteen years ago, it was very difficult for HIV patients to be approved for transplants. The reasons for this were that HIV patients could not yet donate organs, and HIV medications, though in existence, were not yet widely used. Because HIV treatment has improved so much in the past fifteen years, insurance companies (who have to cover the high cost of organ transplants) no longer see HIV patients as people who will not live for very long, and are wasting the organ they are receiving. Beside actually being able to receive transplants, HIV patients will be able to receive these transplants at a faster pace than ever before. The reason for this is that the supply of organs from all patients will be greater because of the allowance of HIV positive organ donations, but the demand for organs will most likely stay consistent, if not decrease, as it has in approximately the last ten years (see graph 1). Additionally, this will allow HIV negative patients to receive transplants faster, since “HIV-infected patients can draw from a unique organ supply which is inappropriate for the majority of patients on the waitlist” (Medical and Transplant Information). The meaning of this quote is then even though HIV negative patients cannot receive HIV positive transplants, they will still benefit from them. In summary, HIV positive organ transplants are causing more people with HIV to be recommended for transplants, in addition to receiving those transplants. This is then helping those who are not HIV patients to receive transplants faster.
Graph 1: Number of Patients Waiting for Organ Transplants, Organs Transplanted, and Organs Donated per Year From 1991-2015
Nonmaleficence vs Beneficence
The next set of ethical values I considered was nonmaleficence vs. beneficence. These values are connected to HIV positive organ transplants because it is very important to ask whether one outweighs the other, as the life of a person could be at stake. The argument for organ transplants with HIV positive organs being beneficent is that historically, it has been very difficult for people with HIV to receive organ donations, let alone survive until an organ was available. The reasons for this include legislation and insurance companies denying financial assistance for HIV patients, as well as a lack of HIV treatment. Now that people with HIV are able to receive HIV positive organs, I believe that doctors should be allowed to give these organs to them. These HIV positive organs will save their lives. Without these transplants, hundreds will perish in the future, just like it has been in the past. Nothing about the condition of the person with HIV will change when they receive an HIV positive organ, other than the replacement of a failing organ. HIV patients are often eager to receive these organs.
“It was an easy decision for me. I already had HIV, I had hepatitis C, I had renal failure. I was like, ‘Yes, I’ll sign anything. Just give me an organ.’”Reynaldo Garza, an elderly resident of California
For Garza, the risks of continuing to live with both HIV and kidney failure did not outweigh the many benefits of receiving a new HIV positive organ, and the action was, therefore, beneficent in his eyes. This quote brings the statistics and facts of HIV positive organ transplants and how many lives they can save to life. It also emphasizes the fact that it is important to heart from all audiences when evaluating these ethical principles, since ethicists and medical professionals may not be literally living through the dangers and uncertainties of HIV and the side effects and conditions that come along with it. To truly classify HIV positive organ transplants as beneficent or maleficent, we must ask whether it affects society and its’ people positively.
There is also an argument for HIV positive organ transplants being maleficent, and therefore violating the Hippocratic Oath. Even if the person receiving the HIV positive organ already has HIV, replacing one problem with another should not be allowed. This could be compared to artificial hearts, which patients are sometimes given if they do not have enough time to wait for a real heart. Are these substitutions maleficent? Do they give false hope, or are they giving life back to patients who might have lost it? This is a situation in which we must question our own morals and consider the risks and benefits of these transplants. Personally, I believe that giving hope and life back to people who were close to losing it is a wonderful opportunity. Caplan had an interesting perspective on the interaction between beneficence and nonmaleficence in relation to HIV positive organ transplants.
“I think that using high-risk organs makes sense. However, patients have a right to know. Patients also have a right to say no if they don’t want to do it. Until we establish whether this is safe and effective, we have to treat it as research, not just as rescuing someone from death.”Caplan
This quote relates to the risks and benefits discussed above, as it highlights that HIV positive organ transplantation is still a new procedure, and that we must treat it with the correct amount of carefulness. However, I believe that if we treat it with too much carefulness, we may not be able to advance in the medical field in terms of this procedure, or any related procedure. As emphasized by the possibilities for advancement and the difficulties that HIV patients have faced with receiving organ transplants in the past, is it of utmost importance that we, as a society, truly think about the ethical values that intersect with HIV positive organ transplants and how this medical procedure will positively and negatively affect people.
In relation to the ethical issue of justice, I decided to ask two questions. I first questioned how justice was violated in the past in relation to HIV positive organ transplants. I believe that justice was violated when the Organ Procurement and Transplantation Network (OPTN) stated, through NOTA in 1988, that they would:
“…use standards of quality for the acquisition and transportation of donated organs, including standards for preventing the acquisition of organs that are infected with the etiologic agent for acquired immune deficiency syndrome.”(42 USC 274: Organ Procurement and Transplantation Network).
The OPTN leads all organ transplantation and donation in the United States. The “etiologic agent” written of in this passage is HIV, and this legislation disallowed doctors, hospitals, and all other organizations from experimenting with HIV in conjunction with transplantation. Even though HIV was still very dangerous in 1988, I believe that there should not have been a law that prohibited all experimentation, as this could have led to scientific advances and progress earlier on. If medical professionals had been allowed to experiment with HIV positive organs, effective treatment for HIV might have been created before 1995, HAART was released to the public. Although other HIV treatments had been produced earlier, HAART is the only treatment that significantly lowers death rates (Bartlett). But what if HIV positive organ transplants did not help with the development of HIV treatment? It still would have given those who were dying rapidly of AIDS a chance to live for a few more months or years than expected. It most definitely would have lessened the social stigma around HIV, if not at least familiarized medical professionals, who were not immune to the fear that came along with HIV, with knowledge about the virus. Even despite these medical and social benefits, one could also argue that the legal actions of the OPTN did not violate justice.
As stated above, at the time when this piece of legislation was passed, HIV medication was neither readily available, widely used, nor very effective. Therefore, HIV was still a virus that would, more often than not, lead to death. In this situation, the OPTN had to consider what was greater: the risks of allowing HIV positive organ transplants, or the benefits of allowing them. This is something we must still do today to decide how to regulate HIV positive organ transplants, which is why my next question is incredibly important.
The second question I asked was whether the limitations we currently have on organ transplants are just. One argument is that the waiting list currently used could be qualified as unjust, as it does not allow people who are HIV negative to receive HIV positive organ transplants. However, the limitations that are currently placed on organ transplants could be qualified as just, since, as I stated before, it has been very difficult in the past for HIV patients to receive organ transplants, so they should be prioritized for HIV positive organ transplants. This difficulty and the experiences that HIV patients had with organ transplants in the 1980’s and 90’s led me to wonder whether HIV patients and the medical professionals who fought alongside them for equal rights in terms of transplantation are satisfied with less than what is just. After so much hardship, just having these transplants allowed for HIV patients alone could seem like enough. Yes, it could be seen as maleficent to willfully infect patients with HIV through organ transplantation.
However, HIV is no longer “invariably fatal”, and it is now a “treatable chronic disease.”Cohn
For these reasons, should HIV negative patients be allowed to receive HIV positive organs? I do not believe that society is yet willing to accept a procedure that purposely infects someone with HIV, but my opinion is that this is what the future holds. I believe that there are and will be many people who are more than happy to accept HIV instead of dying while waiting for an organ. This does bring up other issues, such as whether allowing this procedure would unfairly deprive HIV patients. My belief is that even if in the future people who are HIV negative are allowed to receive HIV positive organs, people who are HIV positive should be prioritized for these transplants.
As I stated above, it was very challenging for HIV patients to receive organ donations in the past. Now that they can receive these organs, they should not have to wait as long as HIV negative patients, who, unaffected by HIV and AIDS, have been fully able to receive organ transplants in the past. It may be thirty years until society is ready to accept the transplant of HIV positive organs into HIV negative patients as a possibility, but the fact that HIV positive organ transplants between HIV patients seemed preposterous thirty years ago is evidence itself that ideologies and attitudes change. It is even possible that a more effective treatment or a completely new cure for HIV will be found in the next thirty years, if not sooner. The future of HIV positive organ transplants may seem uncertain, but by evaluating ethical values such as justice and fairness, we can determine what we believe is ultimately ethical in terms of this procedure.
Fairness and Autonomy
The next values I considered in relation to HIV positive organ transplants was fairness and autonomy, and whether the Organ Donor Registry, the system by which people register to donate and receive organs, is fair. One view is that this system is fair for HIV positive patients, since it gives those who have not had the chance to receive an organ in the past the ability to do so now. In the past, those with HIV were often stripped of their autonomy in terms of organ transplants.
Dorry L. Segev, a doctor at Johns Hopkins, “watched in frustration as one HIV-infected patient after another died waiting for organs while available HIV-infected organs were being discarded because HIV-to-HIV transplants were prohibited.”Cohn
HIV patients were denied organs by insurers, since the lifespan for a person with HIV was so short. In addition to this barrier, transplants between HIV patients were illegal. This same argument can be used to justify that the Organ Donor Registry is fair to HIV negative patients. Allowing HIV positive organ transplants will not only save the lives of HIV patients, it will also take around 500 people (who receive HIV positive organs) a year off the organ transplant waiting list. Even though only people with HIV can currently receive HIV positive organs, this is a positive action for both HIV positive and HIV negative patients. Taking people off the organ waiting list means that more people, both with and without HIV, will proceed upward on this list and be able to receive transplants. This is extremely beneficial, as around 600 people a month die while waiting for an organ transplant. As I discussed in the previous section, it could also be asserted that the waiting system used is unfair to HIV negative patients.
Finally, I thought about how autonomy affects fairness in relation to HIV positive organ transplants. The major ethical issue surrounding autonomy in relation to HIV positive organ transplants is the possibility that HIV patients who need organ transplants could be coerced into receiving an HIV positive organ. The reason for this is that HIV patients can currently be listed on both the waiting list for HIV positive organs and the waiting list for HIV negative organs. Although it is illegal and unfair to do so, doctors, family, or other interested parties may try to persuade an HIV patient to receive an HIV positive organ. An entity might try to do this because they think that it is wrong for HIV positive patients to receive uninfected organs, and that those organs should go to people who cannot receive HIV positive organs. This is a potentially valid argument, as it could be considered unfair that HIV patients are eligible for two types of organs (HIV positive and negative).
Yet, there are not as many donations of HIV positive organs as there are HIV negative organs. If HIV patients were limited to only HIV positive organs, there would be fewer chances for receiving a transplant, just as there were in the past. When people attempt to coerce or impose their opinions on others, such as an HIV patient, this takes away that patient’s autonomy and does not allow them to make their own decision about an incredibly important procedure. Is allowing HIV positive transplants worth risking a patient being stripped of their autonomy? Or does the benefit of being able to save many more lives because of these transplants outweigh this risk? My personal belief is that the benefits outweigh the risks in this situation, since the statistical data shows the great number of lives that have been and can be saved through the allowance of this procedure.
HIV positive organ transplants will change organ donation in many ways, some positive and some negative. One positive impact will be allowing people who were previously denied organs a chance to receive transplants, as well as helping all people who are in need of an organ to be able to receive that organ sooner than previously possible. Unfortunately, HIV positive organ transplants might also have a slight negative impact, as hospital mistakes do happen, and there is currently very little knowledge about HIV positive organ transplants among the medical community and beyond. However, this is also a positive aspect of HIV positive organ transplants, since learning and advancement around this procedure will only grow. We must consider whether these transplants are just in relation to the organ waiting list and who can receive certain types of organs. Autonomy and fairness must also be considered, as the rights of patients are incredibly important. These ethical values are so very significant, since the question that one must ultimately ask is: is it worth it? Do the benefits outweigh the risks, or do the risks ultimately outweigh the benefits? My personal belief is that the benefits outweigh the risks in terms of this operation, but it is important to evaluate, as I have undertaken in this essay, all ethical values related to HIV positive organ transplants, such as beneficence, nonmaleficence, justice, fairness, and autonomy, before coming to a conclusion.
HIV positive organ transplants open new medical opportunities. If transplants between HIV patients are allowed, what comes next? Cancer patients, hepatitis C patients, and a second donation of already transplanted organs are all on the table. Hepatitis C affects the liver and kidneys, just as HIV does. Transplants of organs that have hepatitis C are very similar to transplants of HIV positive organs, but research around hepatitis C and organ transplants has been performed and allowed for a longer amount of time (Hepatitis C Antibody Positive Donors). Additionally, those with a certain type of cancer might be able to donate organs that are not affected by the cancer they have. For example, transplants of organs other than the brain between brain cancer patients and healthy individuals have occurred in the past, and the healthy recipients did not receive brain cancer. This could give cancer patients the chance to donate organs and those with or without cancer the chance to receive a healthy organ (Can I Donate My Organs If I’ve Had Cancer?). Lastly, people have recently begun to experiment with transplanting organs for a second time. One example of this would be if a person who had just received a transplant was involved in a car crash. If the organ they had received was undamaged, it could be transplanted into another person who needs it. I think that these are all superb ideas that should be further researched and experimented with as soon as possible. I am of the opinion that it is inevitable that HIV positive organ transplants will change how we as a society think of both organ transplants and HIV. HIV positive organ transplants and their history are great testaments to how quickly times and attitudes can change. Less than twenty years ago, HIV was a stigmatized and feared virus. Currently, HIV positive transplants are not only legal, but enthusiastically backed my many of the medical community. Of course, the most amazing fact is that patients with HIV can now save the lives of other HIV patients, which is something that people who were alive twenty or thirty years ago never could have fathomed. If medical innovations, such as this procedure, continue to advance, grow, and improve, there are unimaginable possibilities in store for patients, doctors, society, and our future.