HIV-Positive Organ Transplants Set To Begin At Johns Hopkins

Transcript

MICHEL MARTIN, HOST:

Turning now to some news out of the medical world. Earlier this month, officials at the Johns Hopkins School of Medicine announced that they had received approval to begin conducting the first organ transplants from HIV-positive donors to HIV-positive recipients. This comes after a change in the law two years ago that lifted a ban that had been in place since 1988. Now surgeons at Johns Hopkins say they're ready to begin performing liver and kidney transplants on appropriate candidates. Dr. Dorry Segev is an associate professor of surgery at Johns Hopkins School of Medicine. He's been working to allow these kinds of transplant, and he says the issue came to his attention five or six years ago.

DORRY SEGEV: HIV had totally changed as a disease from basically a death sentence in the '80s to now something that's a chronic disease. People live their lives with it. They just need to take antiretroviral medication. And so we're seeing now - kidney failure, liver failure and the need for transplantation in these patients. As we were ramping up, we're putting more and more people on a waiting list. Now, as you know, the waiting list has about 120,000 people on it, so that's kind of a depressing line to wait in. And at the same time, it occurred to me that we were throwing away organs that were infected with HIV that could be used to help people with HIV because of this antiquated law. So it occurred to me, living 30 minutes north of Capitol Hill that (laughter) maybe we should something about this.

MARTIN: How did you start? I mean, a lot of people think - you know what? - that's messed up, that's a silly law, we should fix that.

SEGEV: Right.

MARTIN: But then what do you do?

SEGEV: So the first thing that we did was estimate what the impact would be of a law like this. So we did a study to try to estimate how many potential HIV-positive deceased donors there would be. And it turns out that it's about 500 per year, so if you think about 500 donors per year - deceased donors - that's over 1,000 organs. So that's over 1,000 lives saved. And if that were to happen, it would be the biggest increase in transplantation that we've seen the last decade. When we thought about it that way, we thought - this is highly impactful. And so we published this, we got some media attention for it. And then we got groups from the HIV community, the transplant community, the medical community, patient advocacy groups - they all joined us in our effort. We wrote a bill that would become the HOPE Act - the HIV Organ Policy Equity Act - and started to do what they taught us on "Schoolhouse Rock."

MARTIN: So just going backwards, though, why was it illegal for HIV-positive patients to donate their organs for use in HIV-positive recipients?

SEGEV: Yeah, so this was kind of a quirk of timing. The big congressional law that oversees organ transplantation in the United States that really organized our transplant system came about in the mid-'80s. And the mid-'80s happened to be the AIDS scare. And at that time, AIDS was basically a death sentence. So it was written into that law, at the Congressional level, not the policy level but the statute level, that we can't use organs infected with HIV. And so that stood during the entire AIDS scare.

MARTIN: So just to be clear, though, this was all people who are within the universe of people who already have HIV?

SEGEV: Yeah, so the plan is HIV-positive organs can go into HIV-positive patients. And then we would be selective about who the right donors are, who the right recipients are and how we can properly match them so that somebody doesn't get, for example, a much more aggressive strain of HIV.

MARTIN: I was going to ask you about that. First of all, is there the possibility of so-called super infections - that perhaps a patient has a different HIV strain - is it possible that it would worsen the person's condition?

SEGEV: Yeah, we think that superinfection is a reality and it's something we're going to have to deal with. But if you think about it, if you have a pretty unaggressive strain of HIV and we know that the donor you're getting the organ from was also controlled on the same meds that you're taking, then you will probably remain controlled when you get that organ.

MARTIN: So it's another compatibly factor.

SEGEV: Yeah, I mean, basically, it would be just like all the other compatibilities we consider in transplant.

MARTIN: What about people who do not have HIV who are on the waiting list, does this have any implications for them?

SEGEV: Yeah, so imagine now, we take hundreds or maybe thousands of people off of the list, then everybody behind them moves forward. So people with HIV are benefited directly and everybody else on the list is benefited indirectly. And we're all very excited to get started.

MARTIN: How soon do you think you will? Do you have any sense of when you will be able to actually perform the first transplant?

SEGEV: Yeah, so all of our policies are in place, we're just waiting for the right donor to be the first donor for this.

MARTIN: How do you feel - I mean, this is a - forgive me - such an unscientific question (laughter) - but how do you feel? I mean, this is kind of like a movie for kids. You're like, let's fix this thing and you did. I mean, this is not your area, you're not a lobbyist, you don't - that's not your job.

SEGEV: I'm thrilled that this is possible. I'm thrilled that Congress was receptive to this, that President Obama signed the bill. I'm thrilled that we are now able to do this for people, but I'm most thrilled that now patients with HIV on the waiting list will have a better chance at life.

MARTIN: Dr. Dorry Segev is an associate professor of surgery at the Johns Hopkins School of Medicine. He joined us in our studios in Washington, D.C. Dr. Segev, thanks so much for speaking with us.

SEGEV: Sure. Thanks for inviting me. Transcript provided by NPR, Copyright NPR.