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Should HIV+ persons receive a scarce resources?

This article discusses the ethical considerations and principles for allocating scarce resources, specifically organs and financial support, to HIV+ individuals. It addresses the importance of prioritizing those with the greatest medical urgency and likelihood to benefit, while excluding those unlikely to benefit. The article also explores the challenges and controversies surrounding psychosocial exclusions and the need for evidence-based decision-making.

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Should HIV+ persons receive a scarce resources?

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  1. Should HIV+ persons receive a scarce resources? Bernard Lo, M.D.

  2. Two types of scarce reources • Absolute scarcity of organs • Financial scarcity only (living donor)

  3. Principles of fair allocation • Those with greatest medical urgency • Those most likely to benefit • Exclude those unlikely to benefit

  4. Priorty to those most likely to benefit • Help greatest number of people, not waste organs • Groups with similar outcomes should have similar priority • Need outcomes data • Arguments over data, not principle of benefit

  5. Exclude those unlikely to benefit • Medical • Poor adherence • Active substance abuse • Poor social support • Possibility of bias • Should be based on evidence

  6. Principles of fair allocation • Those with greatest medical urgency • Those most likely to benefit • Those who waited longest • Exclude those who cannot pay • Those who are “unworthy”

  7. Renal dialysis in 1950’s • White males • Leaders in church, Boy scouts • “No place for Henry David Thoreau with bad kidneys”

  8. Renal dialysis in 1950’s • Past contributions to society • Future contributions to society • Traditional social/cultural values

  9. Psychosocial exclusions • Behaviors that lead to illness • Alcoholism, substance abuse • Not cigarette use • Groups stigmatized or marginalized • Public willingness to donate organs

  10. Problems with psychosocial exclusions • Person cannot choose to change behavior • Follow or change public opinion? • Treat similarly situated people similarly

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