The Johns Hopkins Hospital, Baltimore, USA, said it was set to perform the first kidney and liver transplants between HIV-positive donors and HIV-positive patients in the United States, a development that could create a lifesaving pipeline for HIV patients while shortening organ donor waiting lists for all.
Dr Dorry Segev, an associate professor of surgery at the Johns Hopkins University School of Medicine, estimated that organs from 500 to 600 HIV-positive potential donors have gone to waste each year and that allowing those donations could save more than 1,000 people. “That’d be the greatest increase in organ transplantation that we’ve seen in the past decade,” he said.
Since 1988 until November 2013, when President Obama signed the HIV Organ Policy Equity Act into law, medical facilities had been forbidden from such transplants. After receiving approval in January from the United Network for Organ Sharing, which manages the nation’s organ transplant system, Johns Hopkins was prepared to perform a transplant as soon as a suitable organ and recipient emerged, the hospital said.
HIV-positive patients can receive organs from donors without HIV, so the addition of the new organs could also bump those without HIV up the waiting list. About 122,000 people in the United States are on the list, Johns Hopkins said.
Patients without HIV would not receive organs from HIV-positive donors.
Giving HIV-positive patients donated organs was once considered unnecessary. The 2013 HOPE Act reversed a transplant ban that was passed in 1988 — a time when AIDS fears were high — as part of an amendment to the National Organ Transplant Act. Dr David Klassen, the chief medical officer for the United Network for Organ Sharing, said the medical outlook for HIV patients had drastically changed since then. “Nobody would consider transplanting an HIV-positive recipient because everyone knew their life span was short,” Dr. Klassen said. He added that “the notion that HIV-positive recipients could be transplanted arose as a result of their extended life spans.”
Because HIV-positive organ transplants have never been done in the United States, medical facilities do not have systems in place to handle them, Dr. Segev said. He anticipated a trickle of transplants at first until those systems are established, with the rate slowly ticking upward.
At least initially, the focus will be on deceased donors, Dr. Segev said. More studies are required to ensure it is safe for an HIV-positive patient to donate a kidney, he said. Aside from the medical potential, the ability to become an organ donor upon death is welcome news among HIV-positive patients, Dr. Segev said. “People want to leave a living legacy; they want to help,” he said. “And to be stigmatised and told, ‘You can’t help because you’re HIV-positive’ can be devastating. This removes yet another stigma associated with HIV,” he said in a report in The New York Times.