Article

Duke Approved to Transplant HIV-Positive Hearts, Lungs

Duke becomes the only center in the U.S. to offer HIV-positive transplant for all six organs through HOPE Act

Cardiology & Heart Surgery
Pulmonology
Transplant
By
Jordan McCollum
Published
August 6, 2024

Duke Health has expanded access to transplants for patients with HIV. Already approved by the United Network for Organ Sharing (UNOS) for other transplants from donors with HIV, Duke is now the only center in the Southeast and one of only two centers in the U.S. to offer transplants of HIV-positive hearts to patients with HIV as well as the only center in the U.S. approved to transplant HIV-positive lungs.

“HIV has become a very manageable chronic condition,” says Adam D. DeVore, MD, MHS, cardiologist and medical director of Duke’s heart transplant program. “Some patients with well-managed HIV eventually need a heart transplant, and they do really well with transplant in our experience.

“This is something we’ve been hoping to do to expand the donor pool and offer any potential recipients with HIV the opportunity for transplant,” DeVore says. “This capability allows us to expand the donor pool.”

“With the advances we’ve seen in HIV treatment, patients with HIV are going to continue to live longer and longer,” says Jacob N. Schroder, MD, surgical director for advanced heart failure. “They should be treated the same as any other patient at this point and be allowed the same therapies and gold standard of care as the rest of the population.”

“We want to offer transplants to patients with HIV,” agrees John M. Reynolds, MD, medical director of Duke’s lung transplant program. “We look forward to expanding the donor pool and shortening their wait time so these patients can get back to more normal functioning.”

Reducing HIV stigmas with transplant

Patients with HIV have faced an uphill battle from more than just their condition. Until 2013, they were the only patients legally barred from donating organs. Then the U.S. Congress passed the HIV Organ Policy Equity (HOPE) Act, revising previous laws that prohibited HIV-positive organ donation. Now, anyone living with HIV can sign up to become an organ donor, and approved HOPE Act centers can offer transplants of HIV-positive organs.

To receive approval from UNOS under the HOPE Act, a transplant center must demonstrate their ability to care for patients with HIV throughout their transplant journey by successfully transplanting five recipients with HIV for that organ. Duke reached the threshold for heart transplants in the spring of 2024 and lung transplants in the summer of 2024. The recent approvals make Duke the only center UNOS-approved to offer all six HIV-positive solid organ transplant conditions:

  • Heart
  • Lungs
  • Kidney
  • Living donor kidney
  • Liver
  • Living donor liver

Duke physician Cameron R. Wolfe, MBBS, MPH, a specialist in infectious disease including HIV and transplant, anticipates that the HOPE Act will continue to help reverse the bias against the disease: “I’ve found that being able to tell a patient they can be a candidate to be an organ donor removes a layer of stigma. It’s often an empowering conversation for a patient.”

Cameron R. Wolfe, MBBS
There are not many situations where you can look at someone’s history and document quantitatively how well they have done over time at consistently taking complex medication regimens, but we can measure patients’ success directly by looking at their HIV viral load history. This helps predict they’ll do well after transplant.
Cameron R. Wolfe, MBBS, MPH

Shortening the transplant wait list

Schroder notes that Duke is well prepared to offer transplants to patients with HIV. “We have a great transplant infectious disease group: Cameron Wolfe and his colleagues are an integral part of the program for our patients. Their input into the care of all our transplant patients and the relationship we’ve developed have made us ideally suited to HIV-positive transplants.”

Patients with HIV can make good candidates for transplant according to Wolfe: “There are not many situations where you can look at someone’s history and document quantitatively how well they have done over time at consistently taking complex medication regimens, but we can measure patients’ success directly by looking at their HIV viral load history,” he says. “This helps predict they’ll do well after transplant because they’re able to take complex pill cocktails. Current HIV medications are not only more effective at controlling HIV, but they no longer typically have complex drug interactions with any impending transplant medication a patient may need.”

Patients with HIV may receive HIV-negative organs, but if an HIV-positive organ becomes available, it can only be transplanted to a patient with HIV. These patients may have shorter wait times if HIV-positive organs become available. “A patient’s HIV status could give them a competitive advantage for transplant,” Wolfe points out.

“The HOPE Act allows us to use the HIV-positive organs that aren’t being used right now,” Reynolds says. “It gives us a way to utilize more organs and improve organ stewardship, which decreases wait list mortality across the board.”

View of the heart inside the chest cavity
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Referring patients with HIV to transplant

Wolfe says that there are still many challenges to getting patients referred in a timely fashion, and consequently, earlier referrals to transplant centers can help overcome many of the barriers that still exist. A provider should consider referring patients with well-controlled HIV and any of the following:

  • Kidney disease approaching dialysis
  • Any stage of liver disease
  • Any stage of progressive cardiac failure, especially those needing advanced cardiac support
  • Advancing pulmonary fibrosis, emphysema or pulmonary hypertension

“At a minimum, refer patients with HIV at the same time you would normally for other patients,” Wolfe says.

With these approvals, Duke continues to expand access to life-saving treatments. “We’re always going the extra mile to offer heart transplants to as many people in need as possible,” says DeVore.