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The first HIV-positive organ transplants are about to begin in the US

This will save thousands of lives.

FIONA MACDONALD
22 FEB 2016
 

Johns Hopkins University School of Medicine has received approval to transplant HIV-positive livers and kidneys into other HIV-positive patients, and has announced that it's ready to get started as soon as it has recipients and donors locked in.

This will be the first time that HIV-positive organs will be transplanted in the US, and it could save the lives of more than 1,000 people each year, thanks to the estimated 600 HIV-positive patients who have wanted to donate their organs but couldn't in the past due to legislation.

 

"That’d be the greatest increase in organ transplantation that we’ve seen in the past decade," Johns Hopkins surgeon Dorry Segev told The New York Times.

The new approval comes after the passing of the 2013 HOPE Act - a bill that was co-written by Segev and signed by President Obama, which made it possible for people with HIV to donate their organs.

Now, after more than two years of paperwork, Johns Hopkins has finally received approval from the United Network for Organ Sharing to become the first hospital in the US to perform a kidney transplant between HIV-positive patients, and it will also become the first anywhere in the world to perform a HIV-positive liver transplant.

"This is an unbelievably exciting day for our hospital and our team, but more importantly for patients living with HIV and end-stage organ disease," said Segev. "For these individuals, this means a new chance at life."

HIV-positive transplants were first outlawed back in 1988 because of the short lifespan associated with the virus at the time. But since the introduction of antiretrovirals, HIV-positive patients are living longer than ever, and with the right medications, can live just as long as their peers. Which means there's more need than ever before for them to have access to transplants.

"We're seeing now kidney failure, liver failure and the need for transplantation in these patients," Segev told NPR, explaining his motivation for writing the 2013 HOPE Act bill. "The waiting list has about 120,000 people on it, so that's kind of a depressing line to wait in ... At the same time it occurred to me that we were throwing away organs that were infected with HIV."

"Organ transplantation is actually even more important for patients with HIV, since they die on the waiting list even faster than their HIV-negative counterparts," he added.

In South Africa, HIV-positive-to-HIV-positive kidney transplants have already been performed successfully, proving that the technique can save lives. 

The first transplant in the US hasn't been scheduled as yet, but is ready to take place as soon as a suitable organ becomes available and a recipient is identified and prepared, Johns Hopkins has announced.

The biggest risk for patients is what's known as superinfection - the chance that recipients could receive organs from donors that have a more aggressive strain of HIV than they have, and potentially become infected by it. 

This is something the Johns Hopkins doctors will try to avoid by carefully matching recipients and donors based on their HIV strain, as well as the medications they've used to successfully manage the virus. 

"If you have a pretty unaggressive strain of HIV and we know that the donor you're getting the organ from was also controlled on the same meds that you're taking, then you will probably remain controlled when you get that organ," Segev told NPR.

But because of this risk - as well as the lack of research into the safety of a patient with HIV giving up a kidney - the rate of HIV-positive transplants will be slow at first, and the hospital will initially only focussing on organs from deceased donors.

But once the right procedures and systems have been tested, Segev believes the rate will increase rapidly, and will hopefully become a common procedure in the US.

In addition to being a life-saving surgery for recipients of the organ, the move also gives HIV patients the chance to do what many of us take for granted - give something back to the world.

"People want to leave a living legacy; they want to help," Segev told The New York Times. "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."

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