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As medical science progressed in the 21st century – keeping people with access to them alive longer than ever – new ethical puzzles tend to emerge.
Take this one: an infant with a terminal liver disease must be grafted. After waiting on the list for six months for a deceased donor, none arrive, even if the young person is repeatedly admitted to the hospital for life-threatening complications.
Enter the mother – who is willing to give some of her own body – but who is HIV positive.
Is the immediate rescue operation potentially worthy of infecting the infant?
The dilemma is described by doctors at the University of the Witwatersrand in the latest issue of the journal AIDS aujourd & # 39; hui.
"Two aspects of this business are revolutionary," the doctors write. "First, it is a living donation made by an HIV positive person. Second, there is a controlled transplant from an organ from an HIV-positive donor to an HIV-negative recipient, with the potential to prevent recipient infection. "
The transplant center – the Donald Gordon Medical Center in Johannesburg – is the only pediatric transplant program of its kind in all of southern Africa. Since 2013, some 60 children have received live donor transplants.
Doctors, however, are regularly challenged by HIV-positive parents who wonder why they can not donate to their critically ill children, according to the newspaper.
The case of the 7-month-old changed the normal calculations, according to the reasoning of the doctors.
On average, children on the list get their organ within 49 days. But a child waited 181 days, punctuated several times by hospitalizations. While the infant refused and the mother insisted on providing a piece of liver, the doctors' arguments began to change.
"It was obvious that this request now deserved the utmost attention if we were to save the child's life," said the doctors. "The case has been carefully studied from a legal and ethical point of view, and a multidisciplinary group has undertaken a risk-benefit analysis."
Eventually, the international review panel approved the donation in an expedited manner, according to the account.
Prophylactic treatments were administered to the child before the intervention and the mother continued her antiretroviral treatment. When conditions were optimal, the transplant was performed at the age of 13 months.
Doctors were operating on the assumption that the organ transplant would also introduce the virus into the child's system, the paper says.
However, there has been good potential so far. While the child originally had anti-HIV antibodies in the blood, HIV experts subsequently found no trace of active HIV infection during pregnancy. the year since the operation, announced the team.
Although the end result remains uncertain, the mother and child are both alive and well, report the doctors.
"We are currently developing new methods of testing the child and hope to be able to provide a definitive answer to the issue of seroconversion in the future," said Carline Tiemessen, pathologist and cell biologist at Witswatersrand. "For now, the child will remain on antiretroviral treatment until we have a more complete picture."
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