People with HIV will be able to receive kidney or liver transplants from donors who also have HIV, U.S. health officials announced Tuesday.
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Until now, such transplants were only allowed as part of research studies. Otherwise, people with HIV could not donate their kidneys or livers.
The landmark move, which takes effect Wednesday, is expected to shorten wait times for organs for all patients and reduce hurdles to lifesaving care for those with HIV.
It’s also a testament to medical progress in treating HIV and bolsters efforts to lessen stigma around the disease, experts say. In 2023, the Food and Drug Administration eased the blood-donation ban on gay and bisexual men — a remnant of the AIDS crisis. And last spring, a top U.S. pediatricians’ organization said mothers with HIV can breastfeed if they are taking certain medication.
“It’s gone from a death sentence to a completely manageable disease,” said Christine Durand, a professor of medicine and oncology at Johns Hopkins School of Medicine. Durand was the lead author of a study published last month in the New England Journal of Medicine that affirmed the safety of organ transplants between donors and recipients with HIV.
“This study really shows without a doubt that there’s no differences between receiving a kidney from a donor with HIV versus without HIV,” Durand said. “In addition to reducing stigma, this can help reduce inequities for people with HIV.”
Durand’s team followed 198 organ recipients for up to four years. Ninety-nine of them received a kidney from a donor with HIV, and another 99 received a kidney from a donor without HIV. The researchers looked for a range of safety outcomes, including death or kidney failure.
Both groups had equivalent success rates, Durand said. “Patient survival was very high in both groups, kidney survival was excellent. … In some ways, it was a boring study, but it really emphasized the safety of this: There were no significant differences.”
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South African scientists first provided evidence in 2010 that suggested organs could be safely transplanted from donors with HIV to recipients with HIV. After intense lobbying, the U.S. government in 2013 lifted a 25-year ban on the practice with the passage of the HIV Organ Policy Equity Act. This allowed such transplants to occur within research studies – the first one occurred in 2016 at Johns Hopkins, Durand said.
But the protocols were stringent, limiting many transplant centers from offering the treatment, she said. Removing the research restrictions should, hopefully, mean that more institutions will begin offering the treatment to patients with HIV, she said. The new rule should also increase access for all patients who need kidney and liver transplants, regardless of HIV status, because there will be more organs available.
“On the East Coast, where the demand is high, the wait-list can be two to five years,” Durand said. For people with HIV, the wait time is often longer. “This should reduce wait times overall.”
While medical centers will still need to proceed carefully because the practice is new, the outlook is optimistic, Durand said. “Heart and lung transplants are probably the next frontier.”