Back in 2013, a bill called the HIV Organ Policy Equity Act passed the U.S. Senate, one of only 57 to do so that year. This bill reversed an almost 30-year-old law that prevented patients from receiving organs from donors with HIV. Finally, more than two years on, we’re seeing this put into action: A hospital has just been given the green light to perform transplants between two HIV-positive individuals.
Johns Hopkins will make history twice, marking the first institution in the country to perform a kidney transplant using a positive donor and also the first ever to use a liver from a patient with HIV. If these go well, hopefully the transplants can become more commonplace, representing an opportunity to save a significant number of lives each year.
Although HIV medication has transformed HIV from a death sentence to a chronic, manageable disease with a near-normal life expectancy, with this extended life comes a shift in the problems faced by clinicians and patients. For instance, in the era of antiviral therapy, the most common non-AIDS related cause of death is now liver disease, and kidney disease is also a common complication. While these can have a range of causes, including infections, both can also result from drug toxicity.
Both of these are transplantable organs, but because of the Organ Transplant Amendments Act of 1988, HIV-positive patients in need of replacements couldn’t even receive organs from positive donors. Now that’s changed, and the surgery can go ahead as soon as suitable donors and recipients are identified.
A concern that was initially raised with this procedure was that of informed consent – as an experimental procedure, it is difficult to inform patients of the likely risks and outcomes. This was something that doctors faced a few years ago in South Africa while deciding the best options for HIV-positive patients with chronic kidney disease. But in the absence of other options, the transplants went ahead and the results were encouraging. Patient survival rates were comparable to procedures whereby HIV-negative organs were used, at 84 percent and 91 percent respectively after one year. As expected, the figures were slightly lower after five years, at 74 percent and 85 percent, respectively.
Another concern is that of transmitting different or drug-resistant strains between the patients, which could cause serious problems in terms of disease management. But close and regular monitoring should help alleviate this risk, alongside scanning patient viral sequences both before and after the procedure.
With organ shortage being an ongoing problem not just for the U.S. but worldwide, it’s encouraging that actions are being taken to alleviate this ongoing public health burden.
