San Francisco Chronicle - Thursday, September 10, 1992

Some medical ethicists criticized the decision to use a person infected with the virus, saying such patients might be more willing to risk dangerous treatment.

The man, whose name has been withheld, was selected for the transplant even though University of Pittsburgh Medical Center doctors knew he was infected with the virus, said Dr. Richard Cohen, chairman of the panel that approved the operation. "I think it was another confounding variable," Cohen said. "We didn't think -- since he didn't have active AIDS -- it would make any difference.

"Nobody could say one way or the other what difference it would make, what his life expectancy would be," Cohen said.

Some medical ethicists said the man should have been ruled out as a candidate because of the infection.

"This guy was the most vulnerable of vulnerable patients," said Dr. Michael Grodin, a Boston University professor who heads a similar review panel in Boston. "Dying patients should not be used."

The 35-year-old man died Sunday at the University of Pittsburgh Medical Center after experiencing bleeding inside the skull. He had received the animal organ while suffering from hepatitis B, which was destroying his own liver.

The man's surgeons and other medical center officials declined to say whether he had the AIDS virus, citing confidentiality restrictions. The man's name and other details also were withheld at his family's request. Jeffrey Romoff, president of the medical center, said that hospital policy permits transplants for patients with the AIDS virus, but not for those who have fully developed the immunity disorder.

Romoff said the university has performed about 25 transplants for patients who have tested positive for AIDS. He said the baboon liver case will be detailed in medical journals.

Cohen, who heads the medical center's Biomedical Institutional Review Board, said the panel learned of the AIDS infection in informal discussions with the staff of Dr. Thomas Starzl, director of the university's Transplantation Institute.

"It was not part of the approval process," he said. "We just knew it."

Strachan Donnelly, director of education at The Hastings Center, an ethics institute in Briarcliff Manor, N.Y., said the patient's AIDS infection might have made him more willing to undergo the transplant.

"You have a patient saying, 'All right, look, I'm facing death, not only from this liver thing, but from the HIV thing,' " Donnelly said. " 'What have I got to lose?' " A transplant candidate not infected with the human immunodeficiency virus might have made another choice, he said.

Grodin scoffed at Starzl's comments at a news conference Tuesday that the patient's liver "emerged . . . in very good condition" after the man's death.

"That's like the classic joke," he said. "The surgery was a success, but the patient died."

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