nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Friday, June 18, 2010

Organ Transplants Between AIDS Patients. The Technology Can Help Or Harm

Is it good medicine and ethical to transplant an organ from one infected person to another person infected with the same disease?

South Africa has a big problem with HIV.  HIV also causes kidney failure in some cases, requiring dialysis.  And healthy organ donations are uncommon.

So, why not let one AIDS victim benefit another with a healthy, if infected, kidney?  Unlike the situation where someone inadvertently receives an organ from someone who has cancer, or an undetected infection, both donor and recipient share the same infection, are volunteers, and no disease will be transmitted from one to the other.

The report on this appeared in the New England Journal of Medicine this week.  See the USA Today (June 17) article here.

For the record the US has been doing transplants between donors and recipients who have hepatitis C.

But, unlike with Hep C, there are strains of HIV that are more resistant than others, and predicting resistance is not an exact science.  What if the donor organ comes from an individual with a resistant strain of the virus, and is given to someone whose disease is non-resistant?  Will it adversely impact the course of the recipient's illness?  Maybe...even probably.

To simply say that this factor precludes doing such transplants between HIV sufferers is too simple.  The alternative is to watch the potential recipient die.  In South Africa, resources are extremely limited.  Dialysis is relatively non-existent.

The conundrum in this situation is one that was recognized centuries ago.  The phrase, "First, do no harm"  is taught from Day One in medical school, and remains in the forefront of everything doctors do.  But when the alternative to doing a potentially harmful thing is doing nothing, and that "nothing" is potentially even more harmful (dying), it gets...well...complicated.

I've never found a specific guideline for this.  Each case has to be weighed individually.

The only general guideline that applies is more of a caution:  never let our technology get ahead of our ability to decide right and wrong.

Doc D

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