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Duke Performs First Live Kidney Donation Under HIV Organ Policy Equity Act

Approval to use HIV organs may expand donor pool

HIV molecules

Duke Health performed the first live kidney donation from an HIV donor under the HIV Organ Policy Equity (HOPE) Act in North Carolina and the Southeast region, and the second in the United States. The transplant was performed in August.

Norfolk, VA resident Karl Neumann, a transplant coordinator, was the donor. Acutely aware of the shortage of donated organs, Neumann and thousands of others with HIV were impeded from donating by a federal law that barred them  from registering as organ donors or making a living gift of one of their kidneys.

That barrier was lifted with the HOPE Act, which was signed into law in 2013, enabling HIV-positive donors to offer their organs to HIV-positive recipients.

“Duke is the only transplant center in the state and one of just five in the nation currently approved to perform HOPE Act living donor kidney transplants,” said Matthew J. Ellis, MD, medical director of Duke’s kidney transplant program. “Having this option for people living with HIV is a tremendous step and should add more donors of much-needed organs.”  

Neumann, who has been HIV positive for 11 years, became an advocate in his community and beyond, even as laws kept him from donating. As the transplant IT coordinator at Sentara Norfolk General Hospital in Norfolk, Neumann was active in Donate Life Virginia, which manages the registries in that state and works to raise awareness for organ donation. He is now working to raise awareness for the HOPE Act and to encourage more donations.

The procedure was led by Kadiyala V. Ravindra, MD, surgical director of Duke’s living donor program. The donor’s medical care was led by Cameron Wolfe, MD, an infectious disease specialist. Bradley H. Collins, MD, performed the recipient’s transplant; the recipient asked to remain anonymous. 

According to the United Network for Organ Sharing (UNOS), there have been 152 transplants involving donors with HIV since the HOPE Act was authorized. Of those, 109 have been kidney donations from deceased donors; 41 have been liver donations from deceased donors, and two, including the Duke case, have been from living kidney donors.

New HIV medications make transplant a life-saving alternative

Wolfe has worked to assure that the HOPE Act’s implementation in North Carolina could move forward. The state had additional laws governing HIV organ donation that had to be changed.

“We were able to lobby and have those rather old, antiquated rules taken away,” Wolfe says. Before the law was changed, UNOS and transplant centers jointly created the requirements and systems to assure safe and successful implementation.

“HIV medications are now incredibly effective for people living with HIV, making transplant a safe and life-saving alternative to dialysis or liver failure,” Wolfe said. “Additionally, we believe healthy HIV-positive donors should be able to give that ultimate life-affirming gift of transplant.”

Wolfe said HIV-positive organs add a layer of complexity to the transplant process, requiring additional testing for medication and viral compatibility. But most people living healthy lives with HIV can now consider being organ donors. 

While Neumann’s kidney necessarily went to a recipient who was also HIV positive, the expansion of the donor pool to include HIV-positive people is expected to broaden the overall number of potential transplants.

“In terms of the numbers of extra patients that this may offer transplants to, it’s still going to be pretty meaningful in the long run,” Wolfe said. “It’s actually helpful for folks who are HIV-negative, too, because we’re creating ways to bring more healthy donors into the national pool.” 

Transplant centers and organ donation agencies are working to raise awareness within the HIV community, at hospitals and in the broader public that these transplants are safe and that donations could ease some backlog on the waiting list. 

“HOPE Act transplants could be a game-changer,” says David Klassen, M.D., chief medical officer at UNOS. “As people living with HIV learn that they can be organ donors, there could be a significant increase in the number of lives saved through transplantation.”