HIV positive organ donors may benefit non-HIV patients

In March, the first organ transplants from an HIV-positive patient to other HIV-positive patients were performed in the U.S. The surgery, which was done at Johns Hopkins Medicine, transplanted a liver to one patient and a kidney to another. Now the director of the Recanati/Miller Transplantation Institute at Mount Sinai, Sander Florman, MD, says even non-HIV patients may benefit from HIV-to-HIV transplants, since it makes the pool of available organs larger.

More than 120,000 people are waiting for organ transplants in the U.S., with three-quarters of those needing kidneys. Florman says the donor pool for organs has not increased in 20 years. However, one study suggests that about 2,000 potential donors who are HIV-positive die each year. Although those organs would not be given to someone who does not have HIV, those patients now have a better chance of getting a non-HIV transplant.

Florman said that 10 years ago a transplant from an HIV-positive donor, even to an HIV-positive recipient, would never have happened. The reason was that HIV was thought to be an immunosuppressant virus, and that giving someone with HIV a transplant and anti-rejection drugs would suppress the recipient’s immune system even more, theoretically leading them to develop AIDS.

However, after several HIV-positive patients were accidentally transplanted and doctors found that they did well, researchers began to theorize that anti-rejection medications actually worked with HIV medicines rather than worsening the problem of immunosuppression.

There is also concern that an organ recipient will be given a different strain of HIV from the transplanted organ. Florman said a transplant would not be done if doctors know that a patient has a resistant form of HIV.