We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Commentary |

Key Clinical, Ethical, and Policy Issues in the Evaluation of the Safety and Effectiveness of Solid Organ Transplantation in HIV-Infected Patients

Michelle E. Roland, MD; Bernard Lo, MD; Jeffrey Braff, DRPH; Peter G. Stock, MD, PhD
Arch Intern Med. 2003;163(15):1773-1778. doi:10.1001/archinte.163.15.1773.
Text Size: A A A
Published online


PATIENTS WITH human immunodeficiency virus (HIV) infection are at significant risk for end-stage kidney and liver disease, and are therefore potential candidates for solid organ transplantation.115 However, they have been considered poor transplant candidates. In this era of effective antiretroviral therapy, preliminary experience with transplantation appears promising, although critical clinical and ethical questions remain. Thus, it is timely to perform a safety and efficacy study of transplantation in HIV-infected patients. Key clinical issues in the design of such a study include consideration of the patients' history of opportunistic complications and hepatitis C coinfection, and their ability to tolerate antiretroviral drugs when defining selection criteria for study subjects. The ethical questions of resource allocation and the risks and benefits associated with living and cadaveric organ donation must also be carefully considered. To address the concerns of utility and effectiveness for each intervention, the minimum acceptable patient and graft survival rates must be chosen on the basis of current transplant practices. Clinical outcomes data from well-designed trials are critical to ensure adherence to the principle of justice in the organ allocation process.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

21 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles

Care at the Close of Life: Evidence and Experience
Overcoming the False Dichotomy of Curative vs Palliative Care for Late-Stage HIV/AIDS: "Let Me Live the Way I Want to Live, Until I Can't"

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Evidence to Support the Update