Following two groundbreaking transplants last March, Yale New Haven Hospital is now the first hospital in New England approved to perform HIV-positive to HIV-positive organ transplant surgeries.
The certification, granted Wednesday by the United Network for Organ Sharing, makes YNHH one of just six hospitals in the country permitted to execute the complicated surgical procedure. In March, a transplant team from Johns Hopkins Hospital harvested organs from a YNHH patient as part of the first HIV-to-HIV liver transplant in the world and the first HIV-to-HIV kidney transplant in the U.S. YNHH plans to enroll HIV-positive patients who now fall under the approval into its Paired Kidney Exchange Program this month.
“Not only does that mean that individuals get access to organs by increasing the overall pool of organs, but others have shorter waiting time,” YNHH Paired Kidney Exchange Program Director Peter Yoo said. “It’s one of the creative strategies we use to ameliorate the critical shortage of organs in this country.”
YNHH first set the stage for HIV-to-HIV transplants last spring when the family of an infected YNHH patient chose to donate the patient’s liver and kidney to another HIV-positive patient. Because YNHH was not yet authorized to perform the procedure, the organs from the brain-dead patient were harvested by the Johns Hopkins team and transported to Johns Hopkins Hospital in Baltimore, where they were transplanted into two HIV-positive patients.
The March surgeries came three years after the passage of the HIV Organ Policy Equity Act, which President Barack Obama signed in 2013, as well as other regulatory approvals from UNOS. The HOPE Act reversed a ban dating back to the 1980s that prohibited HIV-positive individuals from donating organs and allowed HIV-to-HIV transplants through the clinical trials spearheaded by Johns Hopkins.
The approval expands the organ donor pool by freeing up organs for patients on the waiting list who do not have HIV. As HIV-positive patients have been receiving organ donations for years, the significance of approvals such as Yale New Haven’s lies in enabling HIV-positive patients to also donate organs, according to Alexandra Glazier, president and CEO of the New England Organ Bank. While 17,878 patients received kidney transplants in the U.S. last year — with 218 of those patients being HIV-positive — over 4,200 patients died waiting for a kidney transplant, according to UNOS.
“It’s kind of shocking to think about putting an HIV-positive organ into a patient,” Yale School of Medicine Dean Robert Alpern said. “But if they’re already HIV-positive, it probably doesn’t do any harm. People had to get past the initial thoughts for decades of never putting an HIV-positive organ into anyone.”
Glazier said following the signing of the HOPE Act, YNHH and other hospitals seeking to perform these transplant procedures were obliged to undergo a process, including an institutional review and appointment of a principal investigator to oversee the study.
Alpern described the approval as a positive step for both YNHH and the Yale School of Medicine, adding that the role of academic medical centers such as YNHH is to improve upon already existing health care capabilities. However, he said the approval would likely not be of major interest to non-HIV-positive individuals.
In a Sept. 14 statement, Yale School of Medicine professor of medicine Maricar Malinis said HIV patients are now living longer due to retroviral treatments. Because of the longer life expectancies, HIV-positive patients are more likely to suffer from chronic medical illnesses similar to non-HIV patients.
“End Stage Renal Disease is a growing problem in the HIV population and there is an increased need for kidney transplantation,” she said. “The use of HIV-deceased organs for HIV-transplant candidates will decrease their waiting time. At the same time, it provides an opportunity for our HIV patients to give back to the community by organ donation.”
Over one in eight of the 1.2 million people living with HIV in the United States are not aware of their condition.
Correction, Sept. 20: A previous version of this article misstated the title of Maricar Malinis as professor of surgery. In fact, Malinis is a professor of medicine with a secondary appointment in surgery.