Group advocates HIV-positive fertility assistance

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A person’s HIV status should not necessarily preclude them from receiving assisted reproductive technologies to have children, according to new ethical guidelines developed by the Birmingham, AL-based American Society for Reproductive Medicine (ASRM). The standards issued in February by ASRM say therapies now exist that can greatly reduce the risk of passing HIV, the virus that causes AIDS, to the baby. However, they do not encourage HIV-infected couples to have children and caution that physicians should ensure that parents understand their baby could be infected, regardless of what precautions are taken. Since 1994, the group’s ethics guidelines have discouraged fertility treatment if a potential parent has HIV. The risks of infecting the unborn child were too great.

Special care can reduce risks

Today’s therapies allow many HIV patients to live longer, healthier lives, and most patients are in their prime childbearing years. Special prenatal care can greatly reduce — although not eliminate — the risk of infecting a baby, the society’s ethics committee concluded. According to the Centers for Disease Control and Prevention, an estimated 200-300 infants are born with HIV each year, most thought to have been born to mothers improperly tested or treated for HIV.

The fertility society’s new guidelines, available on-line (www.asrm.org) state:

• Appropriate drug therapy, a cesarean, and no breast-feeding drops an HIV-positive pregnant woman’s chances of infecting her baby from 20% down to about 2% — but the risk isn’t zero.

• If only the potential father has HIV, both mother and fetus could be infected. Unprotected intercourse is not safe. Special sperm washing and testing before artificial insemination appears to greatly reduce risk, but more proof is needed. Couples should be counseled about considering donor sperm, adoption, or not having children.

• If both potential parents have HIV, they must be counseled about the risk of infecting and/or orphaning a baby.

Many couples at risk for genetic diseases, such as cystic fibrosis, attempt conception despite a 25% chance of having an ill child, the guidelines note. Fertility specialists who treat those couples also "should find it ethically acceptable to treat HIV-positive individuals or couples who are willing to take reasonable steps to minimize the risks of transmission."


DA in hockey dad case blocked heart donation

The family of Michael Costin, the Massachusetts man who died after being knocked unconscious in a fight at a hockey rink in July 2000, had wanted to donate his heart, but was prevented from doing so by the district attorney prosecuting the man accused of causing Costin’s death. According to a report in the Jan. 25, 2002, Boston Globe, Middlesex District Attorney Martha Cloakley blocked the donation of Costin’s heart after he was declared brain dead because she wanted to prevent the possibility for allegations that Costin could have died from a pre-existing heart condition rather than the beating.

Surgeons express dismay

Transplant surgeons have expressed dismay that the organ was withheld, saying that doctors would not have accepted an organ that was not healthy and that there was ample evidence to indicate that Costin’s death was caused by brain swelling brought on by internal bleeding.

"With heart transplants, it’s literally a life-or-death situation," Lachlan Furrow, MD, a general internist and director of the ethics program at Boston-based Beth Israel Deaconess Medical Center, told the newspaper. "It’s very, very likely that, because of this decision, someone with heart disease died. I think it’s tragic."

But some ethicists said the interests of justice should hold equal value with that of saving lives. "There’s an obvious value in saving lives using donated organs," argues Ronald Munson, PhD, professor of philosophy and science and medicine at the University of Missouri-St. Louis. "But there is also the interest in making sure we have all the evidence necessary so that justice is served. As useful as it is to have these organs for donation, indeed to save lives, we may have to make an exception here to let justice be done, realizing the price we are paying."


Prisoner heart transplant renews scarcity debate

A California prison inmate serving 14 years for robbery received a heart transplant in January, turning up the heat in the debate over who should get desperately needed, but scarce, human organs. And whether patients who have committed crimes against society "deserve" to receive transplants paid for with taxpayer funds. The transplant, paid for by the California Department of Corrections, is expected to cost $1 million with follow-up care, and occurred as 500 Californians waited for hearts, according to the Associated Press.

The operation saved the 31-year-old inmate from dying of a viral heart condition, says Russ Heimerich, spokesman for the California Department of Corrections. Citing two court rulings in favor of inmate care, Heimerich said, "Our hands are pretty much tied. It’s not a question for this department to decide."

A 1976 U.S. Supreme Court ruling held that it is "cruel and unusual punishment" to withhold necessary medical care from inmates. And in 1995, a federal court ordered prison officials to give a kidney transplant to an inmate whose request had been denied. In addition, the ethics policy of the United Network for Organ Sharing, the organization that oversees the national transplant organ network, outs prison inmates on equal footing with all other patients.

The patient is currently in satisfactory condition at a prison medical facility near San Francisco.