Almost 96,000 people in the United States are on the waiting list for a kidney, and many die each year before their turn comes. About 500 to 600 HIV-positive potential donors per year have kidneys and other organs that could be used to save roughly 1000 HIV-positive individuals, said Dorry Segev, MD, PhD, professor of surgery at the Johns Hopkins School of Medicine and a transplant surgeon. “There are some people with HIV for whom it would be reasonably safe to donate a kidney,” he told Contagion®, citing those with undetectable levels of the virus as an example. “It looks like the HIV itself is a pretty minimal risk factor if the HIV has been well controlled.” This is particularly true if donors meet other standards for donation, such as having a low body mass index.
Are there risks to the HIV-positive recipient who gets a kidney from a living HIV-positive donor? “That’s the million-dollar question that we can now answer because it’s legal to do [this kind of transplant],” Dr. Segev said. At issue is the new strain of HIV that’s introduced into the body of the recipient; however, Dr. Segev feels it’s quite likely that physicians will be able to control it in the same way the patient’s own HIV strain can be controlled. “We can figure out the right drugs…that would cover both strains of HIV,” he said, adding that research will help scientists understand the process by which 1 strain becomes dominant.
HIV-positive kidney patients who are offered a kidney from an HIV-positive donor have the option of accepting or declining and waiting for a kidney from an HIV-negative donor. But given the 5- to 10-year average wait for a kidney in this country, Dr. Segev maintains that unless they’re at the top of the waiting list, HIV-positive kidney patients are much better off accepting kidneys from HIV-positive donors if they become available. In addition, if HIV-positive patients accept kidneys from HIV-positive donors, that frees up kidneys from HIV-negative donors to go to HIV-negative recipients.
The team at Johns Hopkins is evaluating potential donors and encourages anyone who is considering donating to come forward. “If you have someone who wants to donate a kidney to you but has HIV and in the past would have been declined to donate, now the door is opened at Hopkins and at a limited number of other places,” he said.