Transplant is game changer

TOUGH CALL: SURGERY TO PUT PART OF LIVER FROM HIV-POSITIVE MOM INTO HIV-NEGATIVE BABY

Virally suppressed HIV-positive people can help alleviate organ donor shortage.

South Africa has a dire shortage of organ donors. This means doctors struggle to find suitable donor organs for critically ill patients who would die without receiving a transplant.

Sometimes they have to make tough calls, such as using a blood group-incompatible organ to save a patient’s life – even if this comes with additional risk.

About a year ago, we made a tough call of our own: we could save a child’s life by giving the child a liver transplant but risked infecting the child with HIV in the process. The donor was the child’s mother, who is HIV-positive and the child was HIV negative.

South Africa’s law does not forbid the transplantation of an organ from a living HIV-positive donor to an HIV-negative recipient, provided that a robust informed consent process is in place.

But this isn’t universally accepted as best clinical practice because of the risk of HIV transmission to the recipient.

The young recipient had been on the organ donor waiting list for 181 days.

The average time on the waiting list in our transplant programme is 49.

The child’s mother had repeatedly asked if she could donate a part of her liver, but we could not consider this because it was against the policy at the time. Without a transplant, the child would certainly have died.

After much consideration, and with permission from the medical ethics committee at Johannesburg’s University of the Witwatersrand, we decided to go ahead with the transplant. With careful planning we were able to give the child antiretroviral drugs in advance, with the hope of preventing HIV infection.

The transplant, which happened at the University of the Witwatersrand’s Donald Gordon Medical Centre, was a success.

The child is thriving, but at this point we are unable to determine the child’s HIV status. It will probably still be some time before we can be sure.

However, the child is doing very well on antiretroviral treatment. And we know from cases where HIV was transmitted inadvertently that people do as well as those who get an HIV-negative organ.

This operation could be a game changer for South Africa. The country has a large pool of virally suppressed HIV-positive people, who have previously not been considered for living liver donation.

This article was originally published in The Conversation.