The world’s first organ transplants from an HIV-positive donor to HIV-positive recipients took place in Cape Town, South Africa in 2008. Two kidney transplants were carried out at Cape Town’s Groote Schuur hospital in September that year and the surgeons who carried out the operations reported that the operations were quite successful and both recipients of the kidneys were doing well. Before then, the organs of HIV-positive patients were simply discarded and until recently, HIV-positive patients were also not eligible for organ transplants. This is because most experts believed that the organs should go to people with a better chance of survival. However, in the late 1990s, owing to the introduction of potent antiretroviral therapy, survival rate for people living with HIV increased substantially, putting an end to the arguments that they were less likely to live than their HIV-negative counterparts.

In the United States however, there is still an over a decade-old ban on using organs from HIV-positive donors. This ban was put in place in the 1980s around the same time bans were put in place prohibiting people with HIV from donating blood. As at that period, people with HIV were also excluded as viable candidates for receiving organ transplants, which has now been lifted. But the primary challenge now is the availability of viable organs for transplant. This means that many people – both HIV-positive and HIV-negative – die waiting for an organ from a matched donor. A new Johns Hopkins research suggests that if the U.S. Congress reversed its ban on allowing people with HIV to be organ donors after their death, about 500 HIV-positive patients with kidney or liver failure each year could get transplants within months, rather than the years they currently wait on the list.

The study’s senior author Dorry L. Segev, an associate professor of surgery at the Johns Hopkins University School of Medicine said that every single HIV-infected transplant candidate would get organ for transplant if this ban is lifted. “Instead of discarding the otherwise healthy organs of HIV-infected people when they die, those organs could be available for HIV-positive candidates”, he says. Not only would HIV-positive transplant candidates get organs sooner if such transplants were legalized, but by transplanting those patients and moving them off the waiting list, the time to transplant would be shorter for non-HIV-infected patients. Segev reports that the number of HIV-positive patients receiving kidney or liver transplants – with non-HIV infected organs – is on the rise as doctors become more comfortable with the idea, and patients are having good outcomes. The online science news website, ScienceDaily reports that in 2009, more than 100 HIV-positive patients got new kidneys and 29 got new livers. There have been various reports on the toxic effects of anti-retroviral drugs on the liver and kidney. These drugs are used to control HIV-infection in the body but consequently have toxic effects on the liver and kidneys. This and some other factors may lead to complete organ failure. As a result, HIV-infected patients may encounter accelerated rates of liver and kidney disease.

Segev and his colleagues set out in their study, published online in the American Journal of Transplantation, to estimate the number of people who die each year in the United States who are good potential organ donors except for that they are HIV-positive. They culled data from two main sources – the Nationwide Inpatient Study, and the HIV Research Network. The team discovered that the number of annual deaths with what are believed to be organs viable for transplant to be approximately the same – about 500.

There may be risks associated with allowing HIV-positive individuals donate organs for transplant. Some medical and safety issues need to be addressed. Doctors need to ensure that the donor organs are healthy enough for transplant. If the donor organ has been damaged by the illness, this significantly lowers the life span of the organ. There is also the fear hat recipient may be infected with a more virulent strain of the virus in this process. Mislabeling an HIV-infected organ and transplanting it to an HIV-negative person is also another issue to be considered. However, considering the potential benefits of using HIV-infected organs for transplant, these challenges are overshadowed. Patients will have to consider the prospect of a life on dialysis (for those with a damaged kidney), or premature death while waiting for a transplant, and eventually opt to take the risk.