Three medical centers in the United States have now been approved to perform kidney transplants from living HIV-positive donors to HIV-positive recipients. We break down the risks and benefits.
For many years, potential kidney donors with HIV were not allowed to donate their organs because of the risk of transmitting HIV to uninfected recipients. However, the organ-donor landscape has been changing over the past few years. Thanks to the HIV Organ Policy Equity Act, signed into law during the Obama administration in 2013, transplants between HIV-positive donors and recipients now are allowed. So far, there have been roughly 30 transplants between deceased HIV-positive donors and HIV-positive recipients in the United States, but none using a live donor—possibly in part because HIV itself is a risk factor for kidney disease and it’s been considered too dangerous for the donor.
Big changes are coming again, though, with the news that 3 medical centers in the United States, among them Johns Hopkins University, have been approved to perform kidney transplants from living HIV-positive donors to recipients who already have HIV. This is a significant development, both for patients waiting for a kidney and for individuals looking to donate a kidney. It’s preferable to use kidneys from live donors because they last twice as long, on average, as those from deceased donors. They also have a higher chance of being immediately functional in the recipient, whereas kidneys from deceased donors may not work right away, necessitating a period of dialysis.
Almost 96,000 people in the United States are on the waiting list for a kidney, and many die each year before their turn comes. About 500 to 600 HIV-positive potential donors per year have kidneys and other organs that could be used to save roughly 1000 HIV-positive individuals, said Dorry Segev, MD, PhD, professor of surgery at the Johns Hopkins School of Medicine and a transplant surgeon. “There are some people with HIV for whom it would be reasonably safe to donate a kidney,” he told Contagion®, citing those with undetectable levels of the virus as an example. “It looks like the HIV itself is a pretty minimal risk factor if the HIV has been well controlled.” This is particularly true if donors meet other standards for donation, such as having a low body mass index.
Are there risks to the HIV-positive recipient who gets a kidney from a living HIV-positive donor? “That’s the million-dollar question that we can now answer because it’s legal to do [this kind of transplant],” Dr. Segev said. At issue is the new strain of HIV that’s introduced into the body of the recipient; however, Dr. Segev feels it’s quite likely that physicians will be able to control it in the same way the patient’s own HIV strain can be controlled. “We can figure out the right drugs...that would cover both strains of HIV,” he said, adding that research will help scientists understand the process by which 1 strain becomes dominant.
HIV-positive kidney patients who are offered a kidney from an HIV-positive donor have the option of accepting or declining and waiting for a kidney from an HIV-negative donor. But given the 5- to 10-year average wait for a kidney in this country, Dr. Segev maintains that unless they’re at the top of the waiting list, HIV-positive kidney patients are much better off accepting kidneys from HIV-positive donors if they become available. In addition, if HIV-positive patients accept kidneys from HIV-positive donors, that frees up kidneys from HIV-negative donors to go to HIV-negative recipients.
The team at Johns Hopkins is evaluating potential donors and encourages anyone who is considering donating to come forward. “If you have someone who wants to donate a kidney to you but has HIV and in the past would have been declined to donate, now the door is opened at Hopkins and at a limited number of other places,” he said.
Laurie Saloman, MS, is a health writer with more than 20 years of experience working for both consumer- and physician-focused publications. She is a graduate of Brandeis University and the Medill School of Journalism at Northwestern University. She lives in New Jersey with her family.