The first transplant in the world from a living HIV-positive donor to an HIV-negative child has been completed by surgeons at the Wits Donald Gordon Medical Center in Johannesburg, South Africa.
The procedure is giving new hope to a country that has a severe shortage of organ donors.
While the 2013 HIV Organ Policy Equity (HOPE) Act allows scientists to include HIV-positive people when searching for organ donors, surgeons are continuing to move slowly in executing the procedure in the U.S., out of looming concern that the virus will be transmitted via the donated tissue.
At first, the South African doctors at Wits Donald Gordon refused to do the surgery, until the child’s own mother (who is HIV-positive) pleaded with them to reconsider. Her child was born with a birth defect that restricts blood to the liver, reports Bhekisisa. The child had been waiting for a transplant for 180 days, during which the mother was offering to donate a portion of own liver.
Transplant surgeon Jean Botha remembers the mother asking, “Why are you excluding me just because I’m HIV-positive?” But he argued, “We were under the presumption going into this that the child would develop HIV. That was the ethical debate: We had to balance the benefit of saving the child's life against the risk of [contracting] HIV.”
The mother is undetectable, which means her HIV is suppressed to such low levels that she is unable to transmit the virus to others. While doctors were still concerned over her status, they decided to go through with the operation.
A year later, the child has shown no evidence of HIV in their blood, according to Caroline Tiemessen, who heads the Cell Biology Research Laboratory at the National Institute for Communicable Diseases Center for HIV and Sexually Transmitted Infections.
This information is groundbreaking because it further suggests to surgeons that HIV-positive people who are undetectable might very well be able to donate their organs without the virus being contracted by its host.
According to reports, the night before the transplant the infant was given a combination of three antiretroviral drugs to help prevent HIV transmission from the donated liver. Botha said the drugs could have halted the transmission, but that the child will continue to be monitored to confirm the virus remains suppressed.
In 2016, John Hopkins in Baltimore, Md. was the first center in the U.S. to perform an HIV-positive organ transplant from deceased donors — performing both a liver and kidney transplant. This year, Johns Hopkins was approved to perform transplantation using a kidney from a living HIV-positive donor into an HIV-positive recipient.
The success gives hope to many, even here in the United States, who are still on waiting lists for donors. According to HIV.gov, up to 30 percent of those living with HIV suffer from abnormal kidney function issues, which, left untreated, could turn deadly.
As Plus previously reported, a number of comorbidities common in those living with HIV also increase the risks of kidney damage, including high blood pressure (which HIV-positive people are three times more likely to develop), diabetes (which poz folks are four times more likely to develop), and hepatitis C (which approximately one out of every four people with HIV also have).