South Africa Pioneers HIV-Positive Transplants

Cape Town surgeons recently conducted the first organ transplants from one HIV-positive patient to another, opening up a procedure that South African authorities once banned for those infected. Nearly a third of potentially transplantable organs are discarded in South Africa because the donors were HIV-positive.

Dr. Elmi Muller of the Groote Schuur hospital performed the surgery in late September, transplanting kidneys from an HIV-positive organ donor into two HIV-infected patients. The patients are in "excellent" condition, the transplanted kidneys are functioning well, and there are no signs of rejection, she said.

"HIV patients are at a disadvantage when it comes to getting an organ and dialysis," said Muller. "Even when we try to be fair, they are at a disadvantage competing with people with no chronic illness. This study opens up an opportunity to help them, even gives them a slight advantage, because of the high number of HIV-positive donors."

Continuing success with the procedures could pave the way for the transplantation of other organs. These could include livers and hearts, which can be damaged by HIV drugs and infection.

Transplants from HIV-positive donors to HIV-positive recipients could be controversial, however, since mixing HIV strains may fuel resistance to HIV treatment. In addition, HIV-infected organs could be damaged and lose their durability as transplants.

"[If you have] renal failure and HIV, you get told to go home and die," said Dr. June Fabian, a consultant nephrologist at Johannesburg hospital. "HIV-positive to HIV-positive [transplants] come from having limited resources and knowing that the patient is going to die. Positive to positive is the last alternative."

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