Key Takeaways
- Only advanced centers, such as Duke’s Living Donor Kidney Transplant Program, offer living donor kidney transplant from patients with HIV.
- Living donation offers convenience for donors and shorter wait times for patients, with optimal outcomes.
- Living donation through paired donor exchange and remote donation, donating right kidneys and those with multiple arteries, and other advanced procedures distinguish Duke Health as a transplant center.
When a loved one needed a transplant, a 65-year-old man was prepared to donate his kidney, but he wasn’t a match. Paired donation through the National Kidney Registry (NKR) offered another option, where the donor’s kidney could go to a well-matched recipient and his loved one would receive a voucher for their own transplant. However, the donor’s well-controlled HIV posed an additional challenge.
The donor contacted programs across the country that could handle a donor with HIV for paired exchange. HIV-positive organs can only be transplanted into recipients with HIV, narrowing the recipient pool. Only two programs responded affirmatively, and the Duke Living Donor Kidney Transplant Program (DLDKTP) was quicker to evaluate and work up the donor for transplant.
How did Duke’s Living Donor Kidney Transplant Program enable this patient to donate?
The unique case required advanced expertise and care pathways. “We actively worked with the NKR to make this happen. They had never done this before,” says kidney transplant specialist Gayle Vranic, MD, MSCR, director of living donation for Duke kidney transplant. “Our established processes help to efficiently prepare and approve patients for living donation.”
“The innovative workflow we’ve built together has been very successful,” agrees abdominal transplant surgeon Meera Gupta, MD, MSCE, surgical director for DLDKTP.
The donor was able to donate at the center and time of his choice, and his loved one received a voucher from NKR for a future living donor kidney. “Living donor transplants offer the best results,” says Vranic. “We do everything we can to help a patient achieve the best type of transplant.”
Not all living donor programs are the same, Vranic adds. “The closest center is not always the best option,” she says. “Donors or recipients who are not approved at other centers may be approved at Duke.”
As this case shows, HIV status is not an automatic disqualifier for donation. “HIV is a chronic condition now,” says Vranic. “Patients with HIV can live long and happy lives. At Duke, every day, we’re helping patients achieve donation and expanding access to donation by also considering donors with well-controlled HIV who are otherwise healthy.”
Duke’s Kidney Transplant Program performs advanced procedures for cases ranging from straightforward to complex. The program offers options that may not be available at all centers, including living donation through paired donor exchange and remote donation. Duke routinely considers and approves donors over the age of 65, donating right kidneys, those with multiple arteries, and those living with chronic conditions like hypertension and HIV who are otherwise at low risk of developing kidney disease in the future.
Early referral in end-stage kidney disease is important for effective treatment. “When the GFR [glomerular filtration rate] for a patient with chronic kidney disease declines to 20 or below, they should be referred to Duke for evaluation,” Gupta says. “Patients with living donors may be able to avoid the waitlist and dialysis entirely.”