Published On: Fri, Mar 29th, 2019

Doctors perform first ever organ transplant from HIV-positive living donor

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Washington — Surgeons in Baltimore have performed what’s thought to be the world’s first kidney transplant from a living donor with HIV, a milestone for patients with the AIDS virus who need a new organ. If other donors with HIV come forward, it could free up space on the transplant waiting list for everyone.

Nina Martinez of Atlanta traveled to Johns Hopkins University to donate a kidney to an HIV-positive stranger, saying she “wanted to make a difference in somebody else’s life” and counter the stigma that too often still surrounds HIV infection.

Many people think “somebody with HIV is supposed to look sick,” Martinez, 35, told The Associated Press before Monday’s operation.

In a press conference on Thursday, she said she “wanted to do something to jolt people’s perceptions” of HIV. “I wanted to show that people living with HIV are just as healthy,” she said.

Dr. Christine Durand, an infectious disease physician at Johns Hopkins, said the recipient, who has chosen to remain anonymous, is “recovering beautifully and incredibly grateful for this gift.” The recipient is expected to be discharged from the hospital in the next couple of days.

Hopkins surgeon Dr. Dorry Segev called the procedure “not only a celebration of transplantation but a celebration in HIV care.”

Nina Martinez and Dr. Dorry Segev, professor of surgery at the Johns Hopkins University School of Medicine.

Johns Hopkins Medical Center

“Here’s a disease that in the past was a death sentence and now has been so well controlled that it offers people with that disease an opportunity to save somebody else,” said Segev, who pushed for the HIV Organ Policy Equity, or HOPE, Act that lifted a 25-year U.S. ban on transplants between people with HIV.

There’s no count of how many HIV-positive patients are among the 113,000 people on the nation’s waiting list for an organ transplant, though Durand estimates it’s around 10,000. HIV-positive patients can receive transplants from HIV-negative donors just like anyone else.

Only in the last few years, spurred by some pioneering operations in South Africa, have doctors begun transplanting organs from deceased donors with HIV into patients who also have the virus, organs that once would have been thrown away.

Since 2016, 116 such kidney and liver transplants have been performed in the U.S. as part of a research study, according to the United Network for Organ Sharing, or UNOS, which oversees the transplant system. One question is whether receiving an organ from someone with a different strain of HIV than their own poses any risks, but so far there have been no safety problems, said UNOS chief medical officer Dr. David Klassen.

Hopkins’ Segev said Monday’s kidney transplant was a world first. Doctors had hesitated to allow people still living with HIV to donate because of concern that their remaining kidney would be at risk of damage from the virus or older medications used to treat it.

But newer anti-HIV medications are safer and more effective, Segev said. His team recently studied the kidney health of 40,000 HIV-positive people and concluded that those with well-controlled HIV and no other kidney-harming ailments like high blood pressure should face the same risks from living donation as someone without HIV.

“There are potentially tens of thousands of people living with HIV right now who could be living kidney donors,” said Segev, who has advised some other hospitals considering the approach.

Generally, kidneys from living donors last longer, added Dr. Niraj Desai, the Hopkins surgeon caring for the recipient. And if more people living with HIV wind up donating, it helps more than HIV-positive patients who need a kidney.

“That’s one less person waiting for a limited resource,” Desai said. “That helps everybody on the list.”

Segev said he’s already received calls from other people living with HIV who are looking to donate organs.

“I hope that across the country transplant centers will have the same experience,” he said. “People were waiting for the first one to happen and to see that it’s safe to do.” Now that that’s happened, he expects others in the U.S. and around the world to follow.

Martinez, a public health consultant, became interested in living donation even before HIV-to-HIV transplants began. Then last summer she learned that an HIV-positive friend needed a transplant, and tracked down Segev to ask if she could donate.

Her friend died before Martinez finished the required health tests but she decided to honor him by donating to someone she didn’t know.

“It’s bittersweet that I couldn’t give my kidney to the person I wanted to. But I know my late friend would be glad to know that I continued” with the process.

A runner who plans on making this fall’s Marine Corps Marathon, she said she knew she was the one the surgeons at Johns Hopkins had been waiting for. “I knew I was probably just as healthy as someone not living with HIV who was being evaluated as a kidney donor,” she said. “I’ve never been surer of anything.”

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