New Illinois Law Permits Organ Donors With H.I.V.
By MONICA DAVEY
Published: July 16, 2004
Gov. Rod R. Blagojevich of Illinois signed a bill on Thursday allowing
people who are H.I.V. positive to donate organs to others infected with
H.I.V., a provision that he called the first of its kind in the United
State Representative Larry McKeon, the Chicago Democrat who wrote the
bill, said the decision was certain to save the lives of people with
H.I.V., the virus that causes AIDS, who are waiting for liver
transplants but have always been barred, as is everyone, from receiving
donations from those with the virus. Mr. McKeon, 60, is himself H.I.V.
positive and said he had been for 15 years or more. He said he was proud
now to check off the box on the back of his Illinois driver's license,
agreeing to become something he had not been allowed to be: an organ
Some doctors and advocates for people with AIDS said the move by
Illinois was certain to prompt similar actions in other states - and
perhaps even a national shift in the rules that bar people with H.I.V.
from becoming donors, despite what these advocates describe as the
perfectly safe option of donating organs to other infected people. But
federal authorities raised questions about the Illinois law, and said
that any move to allow H.I.V.-positive organ donors would violate
provisions of the National Organ Transplant Act of 1984.
"The federal law specifically states that no organs can be donated by
those with H.I.V.," said Kevin Ropp, a spokesman for the Health
Resources and Services Administration, part of the Department of Health
and Human Services. "The purpose was to prevent the spread of H.I.V. and
Lawyers for Mr. Blagojevich, however, said they had interpreted the
federal organ donation procedures differently and believed Illinois
could proceed as planned with its law, which went into effect as soon as
it was signed on Thursday, said Abby Ottenhoff, a spokeswoman for the
governor. The lawyers acknowledged that Illinois doctors may need to
seek certain variances to the regulations, but said that exceptions had
been granted in the past, and that this was a logical next step.
"We're hopeful that by removing an obstacle in Illinois, they'll be able
to make change at the federal level," Ms. Ottenhoff said.
Details of how Illinois's plan will work are far from being sorted out.
Advocates said it would essentially require the creation of a separate
organ donor pool in the state just for those with H.I.V. As is already
the case, all organ donors would continue to be screened for infection,
disease and other problems. In years past, people with H.I.V. were not
considered good candidates for receiving organs because of their reduced
life expectancy. That was because drug treatments were far less advanced
and life expectancies of potential H.I.V.-positive organ recipients were
"This was not a topic five years ago, but it certainly is now,'' said
David Munar, associate director of the AIDS Foundation of Chicago. "And
that tells you something about how things have changed."
Mr. Munar said that the number of people with H.I.V. who are waiting for
organ transplants was unknown, but that their most common need was a
liver, since the livers of those with both H.I.V. and hepatitis C tend
to fail especially swiftly. Donor wait lists can now be years long - too
long, in many cases, for those with H.I.V. and hepatitis and failing
In Springfield, Representative McKeon won his fight to pass the organ
donation legislation with little trouble. It passed the House, which is
dominated by Democrats, 95 to 22, and the Senate, also dominated by
Democrats, with 55 in favor, 2 opposed and 1 "present." The legislation
applies to organ donors with H.I.V. or full-blown AIDS, and to those who
are living at the time of the donation as well as to those who have just
died. It applies only to organ donation, not blood donations or bone
The most serious questions Mr. McKeon said he received were related to
safety. Some colleagues wondered: How can a doctor ensure that an H.I.V.-negative
patient does not accidentally receive the organ of someone with H.I.V.?
And can there be any additional danger to those who already have HIV
from a different strain of it?
"There are reasonable fears," Mr. McKeon acknowledged. "But my position
and the position of the medical people is that this doesn't add any
Human error that could occur in any organ donation situation - where a
donor has the wrong blood type or an unrecognized problem like rabies
(as in a recent set of fatal cases) - is no more likely in cases
involving those with H.I.V., he said.
Dr. Robert Murphy, a professor of infectious diseases at Northwestern
University, said he believed that the transfer of organs from one H.I.V.-positive
person to another was safe. But, he said, doctors must be extremely
careful and fully aware of their patients' medical treatments and
"We know what the risks are and we are going to look at it very
closely," Dr. Murphy said. "Let's do it, and if it works, instead of
throwing away these good organs, we can save a lot of people. When you
see someone die of liver disease, you want to do anything to stop it."
"This is safe," he continued. "What's not safe is to let a person who is
infected with H.I.V. just die because they can't get an organ. If there
were lots of organs to go around, you wouldn't have to do this, but that
is absolutely not the case."
But Dr. Robert Harland, a transplant surgeon at the University of
Chicago, said that the practice was untested and that it might be
possible for an H.I.V.-positive person to be infected with a different
strain of the virus during an organ transplant.
"This is in its infancy," Dr. Harland said. "It's totally unknown at
this point in time."
Jo Napolitano contributed reporting from Chicago for this article.