Surgeons at Johns Hopkins Hospital in Baltimore have performed what's thought to be the world's first kidney transplant from a living donor with HIV, a milestone for patients with the AIDS virus who need a new organ.
Nina Martinez of Atlanta traveled to Johns Hopkins to donate a kidney to an HIV-positive stranger, saying she "wanted to make a difference in somebody else's life," show someone with HIV can be healthy enough to be a living organ donor and counter the stigma that too often still surrounds HIV infection.
“For me it was just kind of an opportunity to be the same as anybody else,” Martinez, 35, said Thursday. “I really wanted to do something to kind of jolt people’s perceptions.”
Hopkins, which made the transplant public on Thursday, said both Martinez and the recipient of her kidney, who chose to remain anonymous, are recovering well. Martinez was slated to be discharged from the hospital Thursday and her kidney recipient was expected to be released within the next few days, her doctors said during a news conference Thursday.
"Here's a disease that in the past was a death sentence and now has been so well controlled that it offers people with that disease an opportunity to save somebody else," said Dr. Dorry Segev, a Hopkins surgeon who pushed for the HIV Organ Policy Equity, or HOPE, Act that lifted a 25-year U.S. ban on transplants between people with HIV.
Dr. Christine Durand, an associate professor of medicine and oncology at Johns Hopkins and one of Martinez’s doctors, said Thursday she hopes Martinez’s operation creates a ripple effect that encourages other people with HIV to register as organ donors. If more come forward, it could free up space on the transplant waiting list for everyone.
There's no count of how many HIV-positive patients are among the 113,000 people on the nation's waiting list for an organ transplant, but Durand estimated about 10,000. HIV-positive patients can receive transplants from HIV-negative donors just like anyone else.
Only in the last few years, spurred by some pioneering operations in South Africa, have doctors begun transplanting organs from deceased donors with HIV into patients who also have the virus, organs that once would have been thrown away.
Hopkins became the first U.S. center approved for HIV-positive organ transplants in 2016. In that year the hospital performed the world’s first transplant of a liver from a deceased HIV patient to a person living with HIV, and also transplanted a kidney from a deceased HIV patient to an HIV-positive recipient — the first procedure of its kind in the U.S.
Since 2016, 116 such kidney and liver transplants have been performed in the U.S. as part of a research study, according to the United Network for Organ Sharing, or UNOS, which oversees the transplant system. One question is whether receiving an organ from someone with a different strain of HIV poses any risks, but so far there have been no safety problems, said UNOS chief medical officer Dr. David Klassen.
Hopkins' Segev said Monday's kidney transplant was a world first. Doctors had hesitated to allow people still living with HIV to donate because of concern that their remaining kidney would be at risk of damage from the virus or older medications used to treat it.
But newer anti-HIV medications are safer and more effective, Segev said. His team recently studied the kidney health of 40,000 HIV-positive people and concluded that those with well-controlled HIV and no other kidney-harming ailments like high blood pressure should face the same risks from living donation as someone without HIV.
"There are potentially tens of thousands of people living with HIV right now who could be living kidney donors," said Segev, who has advised some other hospitals considering the approach.
Generally, kidneys from living donors last longer, added Dr. Niraj Desai, the Hopkins surgeon caring for the recipient. And if more people living with HIV wind up donating, it helps more than HIV-positive patients who need a kidney.
"That's one less person waiting for a limited resource," Desai said. "That helps everybody on the list."
Martinez, a public health consultant and longtime clinical research volunteer, became interested in living donation even before HIV-to-HIV transplants began. Then last summer she learned that an HIV-positive friend needed a transplant, and tracked down Segev to ask if she could donate.
It took about nine months of testing to verify Martinez was healthy enough for donation. Her friend died before Martinez finished the required health tests but she decided to honor him by donating to someone she didn't know.
“Losing somebody to both HIV and kidney disease was very hard, but my late friend was very excited to embark on this journey together,” Martinez said Thursday. “Really I just carried on in honoring him. … If it weren’t for his ask for a kidney it wouldn’t have been a serious consideration in my mind.”
A runner who plans on making this fall's Marine Corps Marathon, "I knew I was probably just as healthy as someone not living with HIV who was being evaluated as a kidney donor," Martinez said. "I've never been surer of anything."
The Associated Press Health & Science Department receives support from the Howard Hughes Medical Institute's Department of Science Education. The AP is solely responsible for all content.
Baltimore Sun reporter Sarah Meehan contributed to this article.