Should HIV+ people be allowed to donate organs?
by Michael Cook | 6 Oct 2018 |
A medical team at the University of the Witwatersrand in South Africa has performed an ethically controversial liver transplant from a HIV-positive donor to a HIV-negative patient.
The donor was the 27-year-old mother and the recipient her infant child.
She had insisted on being considered as a donor, but doctors were initially reluctant because international transplant guidelines clearly exclude HIV-positive donors. However, no other donors were available and the child was near death. After extensive consultation the transplant went ahead; the child appears to be healthy and HIV-negative. (Click here for the published case study.)
Writing in The Conversation, two doctors and a bioethicist explain the reasons for their decision.
We took great care to consult widely before doing the transplant. This included speaking to the members of the transplant team, bioethicists, lawyers, experts in the field of HIV medicine and Wits University’s Medical Ethics Committee. The committee’s function is - among other things - to protect patients in medical research, and to make sure doctors are doing procedures for the correct reasons.It was clear that a transplant was in the child’s best interests. The bigger ethical question was whether it was right to deny the mother the opportunity to save her child’s life. A fundamental principle of ethics is to treat people fairly. People with HIV should have the same health care options as everyone else.We, along with the Ethics Committee, agreed that as long as the child’s parents understood that there was a risk the child could acquire HIV, it was acceptable to go ahead with the transplant.Then, to ensure that the child’s parents were properly informed and in the best position to make a decision, we used an independent donor advocate ...This operation has shown that doctors can do this type of transplant, and that outcomes for the HIV positive donor and the recipient can be good. It has also created a unique opportunity for scientists at Wits to study HIV transmission under very controlled circumstances.
Sunday, October 7, 2018
About five minutes before I was about to entrust this newsletter to MailChimp, I heard that the Canadian Medical Association had just withdrawn from the World Medical Association after the WMA's annual meeting in Reykjavík.
The CMA said that the trigger for this dramatic turn of events was the highly unethical behaviour of the incoming president of the WMA, Dr Leonid Eidelman. It accused Dr Eidelman of plagiarism. This was true and not very smart. A few sentences in Dr Eidelman’s inaugural address to the assembly had been lifted from the inaugural address of a former president of the CMA, Dr Chris Simpson. Since Dr Simpson was one of the CMA’s delegates in Reykjavík, it was highly unlikely that this would go unnoticed. Apparently other passages had also been copied from “various websites, blogs and news articles, without appropriate attribution to the authors”.
"As an organization that holds itself as the arbiter of medical ethics at the global level, the WMA has failed to uphold its own standards,” said Dr Gigi Osler, the current CMA president. “The CMA cannot, in all good conscience, continue to be a member of such an organization.”
The WMA Council and the Assembly accepted an apology from Dr Eidelman. He said that he had relied upon speechwriters – a plausible excuse, as he is a Latvian who emigrated to Israel and who speaks English with a heavy accent.
This is not the first time that a WMA president has been accused of moral failings. The immediate past president, Dr Ketan Desai, was elected while facing criminal charges for corruption in India. At the time, medical ethicist Art Caplan urged the WMA to ditch him as morally compromised. It didn’t.
So the Canadians’ reaction seems disproportionate. It is more likely that it was prompted by the WMA’s firm opposition to euthanasia, which the CMA vigorously supports. One of the CMA delegates, Dr Jeff Blackmer, posted a bitter tweet about the irony that an unethical plagiarist had once openly criticised him for being unethical in backing euthanasia.
No doubt euthanasia will continue to split the medical profession. Any comments from readers?
The CMA said that the trigger for this dramatic turn of events was the highly unethical behaviour of the incoming president of the WMA, Dr Leonid Eidelman. It accused Dr Eidelman of plagiarism. This was true and not very smart. A few sentences in Dr Eidelman’s inaugural address to the assembly had been lifted from the inaugural address of a former president of the CMA, Dr Chris Simpson. Since Dr Simpson was one of the CMA’s delegates in Reykjavík, it was highly unlikely that this would go unnoticed. Apparently other passages had also been copied from “various websites, blogs and news articles, without appropriate attribution to the authors”.
"As an organization that holds itself as the arbiter of medical ethics at the global level, the WMA has failed to uphold its own standards,” said Dr Gigi Osler, the current CMA president. “The CMA cannot, in all good conscience, continue to be a member of such an organization.”
The WMA Council and the Assembly accepted an apology from Dr Eidelman. He said that he had relied upon speechwriters – a plausible excuse, as he is a Latvian who emigrated to Israel and who speaks English with a heavy accent.
This is not the first time that a WMA president has been accused of moral failings. The immediate past president, Dr Ketan Desai, was elected while facing criminal charges for corruption in India. At the time, medical ethicist Art Caplan urged the WMA to ditch him as morally compromised. It didn’t.
So the Canadians’ reaction seems disproportionate. It is more likely that it was prompted by the WMA’s firm opposition to euthanasia, which the CMA vigorously supports. One of the CMA delegates, Dr Jeff Blackmer, posted a bitter tweet about the irony that an unethical plagiarist had once openly criticised him for being unethical in backing euthanasia.
No doubt euthanasia will continue to split the medical profession. Any comments from readers?
 Michael Cook Editor BioEdge |  |  |  |
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