People living with HIV can safely receive donated kidneys from deceased donors who died of the virus, a major new study says, as the US government moves to expand the practice. According to research, this could shorten the wait for organs for everyone, regardless of HIV status.

The study, published in New England Journal of MedicineLooked at approximately 200 kidney transplants performed across the United States. The researchers said they found similar results whether the donated organ came from a person with or without the AIDS virus. Researchers at Johns Hopkins Medicine say the findings of their study support formal adoption of the use of organs from HIV donors as standard clinical practice for people with HIV requiring kidney transplants.

HIV kidney transplant not accepted due to fear of infection

HIV-to-HIV transplants have not been accepted as the standard of care due to concerns about organ recipients becoming infected with other strains of HIV – leading to so-called HIV superinfection. According to experts, requiring recipients for ongoing immunosuppression after surgery will either damage the donated organ or cause a resurgence in the recipient’s HIV viral blood counts.

A serious complication of all transplants is that the recipient’s immune system recognizes the donated organ as “foreign” and attacks it, much as it would an invading virus. And so, for this reason, immune-suppressing drugs are used to prevent organ transplant rejection. However, early success in HIV-to-HIV kidney transplantation alleviated these concerns.

How was the study conducted?

For the study, participants who had kidney failure and were HIV positive agreed to receive an organ from an HIV-positive deceased donor or an HIV-negative deceased donor, whichever kidney was available first. Researchers followed the organ recipients for four years, comparing half of them who received kidneys from HIV-positive donors with half of those whose kidneys came from donors without HIV.

The study concluded that both groups had equally high overall survival rates and low rates of organ rejection.

Virus levels increased in 13 patients in the HIV donor group and four patients in the other group, mostly due to patients who failed to take HIV medications consistently, and in all cases returned to very low or undetectable levels. However, researchers attributed these events to recipients not taking prescribed antiviral medications, and viral suppression returned with strict adherence to drug treatment. A superinfection was detected but had no clinical effect on the organ recipient. “This demonstrates the safety and excellent outcomes we are seeing from these transplants,” said study co-author Dr. Dori Segev of NYU Langone Health.

HIV-positive patients fight stigma, outdated state laws

According to experts, people who are HIV positive are actively discouraged from signing up to become organ donors due to stigma and outdated state laws and policies that criminalize the step. Therefore, this result not only helps people suffering from this disease but also frees up more organs in the entire organ pool so that people who do not have HIV can get organs faster.

According to the US Organ Procurement and Transplantation Network, more than 90,000 people are on the waiting list for a kidney transplant. More than 4,000 people died while waiting for a kidney in 2022.

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