Less than a decade ago, using an organ from a person with HIV in an organ donation was a federal crime due to a law passed at the height of the AIDS crisis.
But last week, a medical team from Johns Hopkins Medicine made a major medical breakthrough when they performed the first successful kidney transplant from a living organ donor who has HIV to a recipient who also has HIV.
The procedure was the first of its kind in the United States and potentially paves the way for better access to organs for people living with HIV.
The procedure was performed Monday, March 25. Doctors successfully transferred a kidney from Nina Martinez, 35, to a recipient who wished to remain anonymous, according to a press release.
“This is the first time someone living with HIV has been allowed to donate a kidney, ever, in the world, and that’s huge,” Dr. Dorry Segev, professor of surgery at the Johns Hopkins University School of Medicine, said in the release.
“A disease that was a death sentence in the 1980s has become one so well-controlled that those living with HIV can now save lives with kidney donation — that’s incredible,” he said.
The successful transplant comes after recent strides were made in the acceptance of organ donations from people with HIV.
A mere six years ago, HIV-to-HIV organ transplants weren’t allowed in the United States. All that changed with the federal 2013 HIV Organ Policy Equity (HOPE) Act, which was spearheaded by Segev.
What exactly were the roadblocks to acceptance of these kinds of transplants? The medical community at large has long had concerns in the past that the presence of HIV could lead to complications for donors, such as kidney disease.
With improvements in antiretroviral treatments over the years, people who have HIV not only can live a normal life span now, but the increased risk of kidney disease and other complications are diminished, Dr. Hyman Scott, MPH, the clinical research medical director at Bridge HIV and an assistant clinical professor of medicine at the University of California, San Francisco (UCSF), told Healthline.
“In a similar way to screening the blood supply, all organ donors are screened for potentially infectious diseases,” Scott said.
The screenings are necessary since organ transplant recipients receive medications to suppress their immune system so it doesn’t reject their new organ.
“HIV for a long time was an infectious disease that prevented somebody from donating an organ,” Scott said. “Now modern HIV treatments reduce these serious complications.”
But Scott says medical breakthroughs in treating HIV as well as organ transplant recipients have helped lead to these transplants.
Scott says HIV-to-HIV transplants have certainly taken place before, but from donors who are deceased. This current news of a living HIV-positive donor being able to contribute without any complications — so far, both Martinez and the recipient are doing well — is a game changer.
Scott says it gives added hope for people living with HIV who are in desperate need for organ donations.
Even for people who don’t have HIV, getting an organ donation can be difficult. There are currently more than 113,000 people nationwide who are on the national organ transplant waitlist, according to the U.S. Department of Health and Human Services.
“In general, there is a shortage of organs for transplantation. Unfortunately, there are more people on the transplant waiting list than there are organs for individuals,” Scott said.
Living donors can help bridge the gap for people who are on transplant lists, who are waiting for an organ from a deceased donor.
“Allowing an individual who, either through altruism as a living donor in this case, or in the setting of somebody who might have died who had HIV and wanted to donate their organs after death, I think gives more opportunities in hope for people living with HIV to be able to receive a transplant,” Scott said.
Since the passage of the HOPE Act, 116 kidney and liver transplants have taken place from deceased HIV-positive donors to HIV-positive recipients, Kaiser Health News reports.
Dr. Alan Taege, an infectious disease expert at Cleveland Clinic, told Healthline that while news of Martinez’s donation is a significant development, the medical community still needs to be cautious.
Historically, he says, people with HIV have a higher risk for renal (kidney) disease. Taege explains that part of this has to do with the fact that, statistically, there’s an “overrepresentation of African American and minority patients in the HIV population” — groups that, on their own, have higher risk factors for diabetes and other conditions associated with kidney disease.
“Moving forward, the debate will probably revolve around, what is the long-term outcome for a donor like this who has HIV? Will they be at higher risk for renal failure themselves? What are the drawbacks of considering this avenue for transplantation?” Taege questioned.
He says this is still a one-time trial that hasn’t been accepted as practice. Inevitably, the first of anything to be done is always going to be met with scrutiny, Taege adds.
“The outcome is this will spawn another clinical trial where we can look at the feasibility for HIV-positive living donors to HIV-positive patients. Someone always has to be first, has to have the idea, and then someone has to pick it up and run with it,” Taege said.
Taege points out that the Johns Hopkins Medicine group has been a strong advocate for people with HIV.
“Now everyone will be looking into the long-term outcome for that donor among other things,” Taege said. “One concern that has come up in the past is an HIV-positive organ may contain a different strain of the HIV virus in it that the recipient might not be able to handle with their medications.”
He says these are normal questions that will have to be addressed as the medical community moves forward to perfect ways for HIV-to-HIV organ transplants.
This transplant will likely add to the continued destigmatization of HIV in this country. An estimated 1.1 million people are living with the virus in the United States, according to 2015 figures from the .
Today, many people understand that those with HIV can live and thrive and now even donate a kidney. Compared to the early days of misinformation, from what the virus is to how it’s transmitted, underscores a major cultural shift, Scott says.
Scott and Taege add it’s important to highlight that people with HIV can lead long, healthy lives.
For instance, people with HIV who follow a dedicated antiretroviral therapy regimen can achieve an undetectable viral load. This means they can’t transmit the virus to HIV-negative sexual partners, .
Rigorous public awareness campaigns around this have done a lot to change cultural perceptions, as well as treatment as preventive methods, like pre-exposure prophylaxis (PrEP). This is a daily regimen of two medications in one pill taken by people who are HIV-negative but at risk for contracting HIV.
Recently, the U.S. government announced that it plans to eradicate new HIV and AIDS diagnoses nationally by 2030, even though exact funding for how this will be achieved hasn’t been clearly spelled out.
Scott says all of this, along with Martinez’s kidney donation, is good news.
“I think all of this reflects the change in how HIV is managed and how people perceive it. People with the suppressed HIV virus in their blood have a very, very long life expectancy. It’s not like in the ’80s when somebody was diagnosed with AIDS and the median survival was 18 months,” Scott said.
“In the decades since, now it is approaching the full life expectancy of somebody who does not HIV,” he added.
He says that the “wonderful altruism” of Martinez is a big deal. The high visibility that news received was a “big deal,” too.
Taege echoes those thoughts.
“We cannot cure HIV yet, but I think the bigger picture for the general public is that anything we can do to increase the number of organs in patients who are HIV-positive, or HIV-negative patients, is a good thing for society,” he said.
In March, a team from Johns Hopkins Medicine performed a successful kidney transplant from an HIV-positive organ donor to an HIV-positive patient.
This procedure was the first of its kind from a living donor and comes on the heels of 2013 legislation that lifted the ban on transplants from deceased HIV-positive donors.
Infectious disease experts say the news is significant since it could open up easier pathways for people with HIV to receive needed organ donations. It also underscores society’s growing understanding and destigmatization of HIV.