Determinants of transplant surgeons' willingness to provide organs to patients infected with HBV, HCV or HIV.

The common provision of organs to patients infected with hepatitis B virus (HBV) and hepatitis C virus (HCV), but not to those infected with human immunodeficiency virus (HIV), has been attributed to perceived or real differences in transplantation efficacy among these populations. However, other explanations remain possible. We surveyed all active U.S. transplant surgeons to identify determinants of their views of the propriety of transplantation among HBV-, HCV-, and HIV-infected patients. The 347 surgeons (56.1%) returning completed questionnaires believed that HCV- and HIV-infected patients have similar post-transplant survival (p = 0.9), but that both groups fare worse than HBV-infected patients (p < 0.00001 for both comparisons). Most transplant surgeons considered HBV- and HCV-infected patients to be appropriate transplantation candidates (p = 1.0 for this comparison), whereas one-third considered HIV-infected patients to be appropriate candidates (p < 0.00001 when compared with HBV- or HCV-infected patients). That surgeons are generally willing to transplant HCV-infected patients but not HIV-infected patients, and yet believe these groups will have similar post-transplant survival, suggests that survival estimates alone do not explain surgeons' choices. HIV-infected patients should have equal access to organs unless or until evidence emerges that they fare substantially worse than other potential recipients.