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YNHH patient makes historic HIV-positive organ donation

April 05, 2016

Yale-New Haven Hospital played a major role last month in the country’s first organ transplant between two individuals with HIV.

In mid-March, the family of a Yale-New Haven patient with HIV, whose personal details have been kept confidential, informed their social worker of their wish to donate the patient’s liver and kidney to another individual living with the infection. Transplant surgeon and professor of medicine Maricar Malinis led the team that harvested the organs from the patient, who was brain-dead. The organs were transported to Johns Hopkins Hospital where they were transplanted into two HIV-positive patients on March 19. The kidney transplant is the first transplant in the United States between patients with HIV, while the liver transplant is the first of its kind in the world.

Procedures of this kind were previously prohibited by federal laws, which were first instituted during the HIV scare of the 1980s, Chief Executive Officer of the New England Organ Bank Alexandra Glazier said. But the HIV Organ Policy Equity Act, passed in 2013, allowed for transplants to take place between people with HIV within the setting of clinical research, Malinis said. The March procedure was part of a study being coordinated by Johns Hopkins University, which was the first hospital in the country to be approved to conduct these transplants.

According to Malinis, the Yale-New Haven Hospital patient’s family heard about study currently conducted at Johns Hopkins University and asked the patient’s social worker if donation was possible

“Currently at Yale we are working with the Hopkins [transplant team, but Yale was] not set up [to perform transplant surgery] until November, so everything is still a work in progress,” Malinis said.

Malinis said she contacted Johns Hopkins Hospital and the New England Organ Bank, who coordinated the transplant between the patient at Yale-New Haven and the patients at Johns Hopkins.

Glazier said the procedure was a “win-win.” In addition to the obvious benefits for the HIV-positive recipients of the liver and kidney, HIV-negative patients waiting for organs also benefited, because the procedure could shorten their time on the waitlist.

“This is a landmark case, and it’s groundbreaking because it’s opening up a whole new opportunity for organ donation and translocation in [the United States] to benefit those waiting for transplants that are HIV-positive … and an additional benefit on the donor side is that it will allow those with HIV to share in saving lives through organ donation,” Glazier said. “I think [the procedure] is quite significant on a number of levels, and we are very pleased and honored to have been part of it.”

Glazier also expressed hope that as more hospitals become capable of performing these surgeries, many more organ donations and transplants between people with HIV will occur, providing these opportunities to an ever-expanding pool of donors, recipients and families. She added that several hospitals in the New England region, including Massachusetts General Hospital, are hoping to perform transplants between people with HIV in the future.

Program Director of the HIV Primary Care Training Track at the Yale School of Medicine Lydia Aoun-Barakat emphasized that the transplantation surgery not only opens the door to lifesaving procedures in the future, but will also improve the quality of life of other individuals living with HIV. She added that the procedure helped remove the stigma associated with HIV and instead provided both hope and a “humanization” of the disease.

“HIV-infected individuals are humans and have the right to access all aspects of quality care and innovation in medicine,” Barakat said. “As far at YSM and YNHH, it reflected on the mission of the institution to be the leader in research, patient care and community engagement.”

Malinis described the transplant as a “major breakthrough” in transfer medicine and HIV medicine in general, adding that she sensed that the operation made the public hopeful for the future of HIV medicine.

In a statement, Dorry Segev, the surgeon who presided over the transplantation at Hopkins, expressed his gratitude to the members of the federal government who worked to institute the HOPE Act and make the procedure possible.

“We are very thankful to Congress, the president and the entire transplant community for letting us use organs from HIV-positive patients to save lives instead of throwing them away, as we had to do for so many years,” Segev said.

Sean Fitzpatrick, vice president for communications of the New England Organ Bank, said up to 1,000 HIV-infected patients could be saved from liver and kidney failure each year in the United States if organs from deceased, HIV-positive donors could be transplanted nationwide. He added that this would also shorten the waiting list for uninfected people waiting for organ donations.

“Hopefully this will open up the door to many other donations and transplants,” Glazier said. “The need is there — there are so many waiting for a transplant. This should encourage other organizations and transfer programs with this success underneath us.”

Submitted by Maricar Malinis on August 04, 2016