People with HIV can safely receive donated kidneys from deceased donors who have the virus, according to a large study that comes as the U.S. government moves to expand the practice. That could shorten the wait for organs for everyone, regardless of HIV status.
The new study, published Wednesday in the New England Journal of Medicine, analyzed 198 kidney transplants performed across the United States. The researchers found similar results whether the donated organ came from a person with or without the AIDS virus.
Last month, the Department of Health and Human Services proposed a rule change that would allow these types of kidney and liver transplants outside of research studies. A final rule would apply to both living and deceased donors. If approved, it could go into effect next year.
Study participants were HIV positive, had kidney failure, and agreed to receive an organ from an HIV-positive deceased donor or an HIV-negative deceased donor, whichever kidney was available first.
Researchers followed organ recipients for up to four years. They compared the half who received kidneys from HIV-positive donors with those whose kidneys came from HIV-negative donors.
Both groups had similar high rates of overall survival and low rates of organ rejection. Virus levels increased in 13 patients in the HIV donor group and four in the other group, mostly related to patients who were not taking HIV drugs consistently, and in all cases they returned to very low levels or undetectable.
“This demonstrates the safety and fantastic results we are seeing with these transplants,” said study co-author Dr. Dorry Segev of NYU Langone Health.
In 2010, surgeons in South Africa provided the first evidence that the use of organs from HIV-positive donors was safe in people with HIV. But the practice was not allowed in the United States until 2013, when the government lifted the ban and allowed research studies, at Segev’s urging. At first the studies were with deceased donors. Then, in 2019, Segev and other researchers at Johns Hopkins University in Baltimore performed the world’s first kidney transplant from a living HIV-positive donor to an HIV-positive recipient.
In total, 500 kidney and liver transplants from HIV-positive donors have been performed in the US.
People with HIV have been actively discouraged from signing up to be organ donors because of stigma and outdated state laws and policies that criminalize organ donation for people with HIV, said Carrie Foote, a sociology professor at Indiana University in Indianapolis.
“Not only can we help those of us living with this disease, but we also free up more organs across the entire organ pool so that those who do not have HIV can get an organ faster,” said Foote, who is HIV positive and an organ donor. registered. “It’s a win-win.”
More than 90,000 people are on the waiting list for kidney transplants, according to the US Organ Procurement and Transplantation Network. In 2022, more than 4,000 people died waiting for kidneys.
In a journal editorial, Dr. Elmi Muller of Stellenbosch University in South Africa predicted that the new study will have “far-reaching effects in many countries that do not transplant these organs.”
“Above all, we have taken another step toward justice and equality for people living with HIV,” wrote Muller, who pioneered the practice.
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