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Transferring An Organ From An HIV-Positive Donor

SCOTT SIMON, HOST:

When the baby of an HIV positive mother in South Africa was suffering from liver failure, doctors were confronted with a harrowing choice. Transplant part of the mother's liver to the infant and risk transferring HIV. Or let the child grow sicker, and most likely die. The child received part of her mother's liver and so far there has been no sign of HIV. The surgery is a first and could significantly change the pool of organ donors in South Africa, where about 20 percent of the population is infected with HIV - the largest epidemic in the world. Dr. Harriet Etheredge is a medical bioethicist at Wits Donald Gordon Medical Center, that's where the transplant happened. And she was part of the team of doctors who helped prepare for the surgery. She joins us from Johannesburg. Thanks so much for being with us.

HARRIET ETHEREDGE: Thank you very much for having me on your show.

SIMON: How's the baby doing?

ETHEREDGE: The baby's doing very, very well. We are over a year after the transplant surgery happened now. And to see this child alive and thriving under these circumstances, with this world first case is obviously enormously gratifying. And it really makes us feel good about the decision we made.

SIMON: Well help us understand that decision because you had to weigh a lot of different factors, didn't you?

ETHEREDGE: Yeah. So we knew that there was a really high possibility that through doing the surgery we would give this child HIV. But the other thing we had to weigh is that the child had been on our waiting list for a liver donor for three times the average. And this child was getting really sick, had been admitted to ICU, had needed to be ventilated and we were at the point where the question was literally, would you rather die or live with HIV?

SIMON: What did the parents tell you?

ETHEREDGE: So the parents were saying to us, why can't we donate? We're well controlled, well HIV positive people, we take our medication every day. Why won't you consider us? So there was certainly that wish from the parents and the mom particularly, who was the donor, that she could be a donor. And we had to consider that very carefully because we have to make sure that we promote and enhance the autonomy of our patients as far as possible. So it was interesting that in this case it was very much motivated by a request from this very brave set of parents who wanted to save the life of their child.

SIMON: Dr. Etheredge, do you think this case, the more people know about it, will contribute something to lifting the stigma of HIV in so many countries around the world?

ETHEREDGE: I would like to hope so. You know, HIV stigma is an extremely complicated thing and it's so multifaceted. So for us in South Africa, although we have this very well integrated national AIDS treatment program, HIV is still very stigmatized. And one of the things we would really hope to show through what we've done here is that if you are an HIV positive person and you're on your medication, you're living a normal life, then that shouldn't preclude you from being an organ donor. It shouldn't stop you from having those options that HIV negative people would have. And we hope that by showing that HIV positive people can do this, that that would help to reduce the stigma to some extent. But this is just one case and it's going to take a lot more than one case to make a serious dent in HIV stigma.

SIMON: Dr. Harriet Etheredge, medical bioethicist at Wits Donald Gordon Medical Center in Johannesburg. Thanks so much for being with us.

ETHEREDGE: Thank you very much.

(SOUNDBITE OF DUSTY TRAILS' "CONGA STYLE") Transcript provided by NPR, Copyright NPR.