In many countries, including the United States, it is illegal to procure an organ for transplant from an HIV-infected person. But these laws may soon be reevaluated since it is now possible to better manage HIV and because the demand for organs far exceeds supply. On May 31, a special Medical Grand Rounds featured Elmi Muller, MD, a transplant surgeon from Cape Town, South Africa, who, together with her transplant team, was the first in the world to transplant a kidney from an HIV-positive donor to an HIV-positive recipient. Jay Fishman, MD, associate director of the MGH Transplant Center, introduced her at the event.
HIV is associated with a high rate of kidney disease, and some of the medications used to treat HIV may also cause further damage, Muller explained. As a result, many HIV-positive patients suffer from kidney failure. Previously, few treatment options were available because patients with the virus rarely qualified for dialysis or transplantation in South Africa. Because almost one in four people in South Africa is HIV-positive, uninfected organs are scarce.
Building on the work of a National Institutes of Health study led by Peter Stock, MD, PhD, from the University of California, San Francisco, which showed HIV-positive patients did well after receiving transplants from HIV-negative donors, Muller initiated a protocol for HIV-infected patients to receive organs from HIV-positive donors – with great success. To date, she has performed 14 of these procedures, overcoming both criticism from the government and the complex medical issues of monitoring HIV infection, immunosuppression and graft rejection.
“The message here today is that HIV-positive patients do just as well as HIV-negative patients after transplantation,” said Muller.
Muller – who was named South Africa’s Woman of the Year in 2011 – was in Boston to present her work at the American Transplant Congress held June 2 through June 6 at the Hynes Convention Center. A number of MGH Transplant Center staff presented at the congress and banners created by the center were posted on street lamps outside to encourage organ donation and welcome attendees.
Read more articles from the 06/08/12 Hotline issue.