For the first time, a heart from a donor with HIV has been transplanted into a recipient living with HIV, according to Montefiore Health System in New York City, where the transplant was performed.
Such a transplant was made possible by passage of the HIV Organ Policy Equity (HOPE) Act in 2013, but it took nearly 9 years to see the first successful transplant.
Dr Ulrich Jorde
“This is a milestone for people living with HIV who need a heart transplant,” Ulrich P. Jorde, MD, section head for heart failure, cardiac transplantation, and mechanical circulatory support at Montefiore, told Medscape Medical News.
In the United States, between 60,000 and 100,000 people could benefit from a new heart, but only 3800 transplants were performed in 2021, so there is high interest in expanding the donor pool. According to case reports, HIV-positive people have received only a limited number of heart transplants since 2003.
The wait can be very long, Jorde said, and “many times people die because we can’t find a heart.”
Patient Underwent Kidney Transplant at Same Time
According to a Montefiore press release, the patient is in her 60s, had advanced heart failure, and received the heart as well as a simultaneous kidney transplant in early spring.
“After the four-hour surgery, she spent five weeks recovering in the hospital and now sees her transplant physicians at Montefiore for monitoring,” the announcement stated.
“Several months later, everything looks really good with this heart,” Jorde said.
The transplant is good news for several groups, he said.
HIV-positive patients awaiting their chance for a donor heart may have a better chance of getting a heart quickly since donor hearts from HIV-positive patients can only go to HIV-positive patients and only to those who are on the list of centers that participate in the HOPE Act.
People on the list who do not have HIV also benefit in cases in which a person with HIV who is on the list receives a heart and is removed from the list.
People with HIV who wish to be organ donors can know that if their heart is donated, it could save a life and they may inspire others to donate.
“It’s a win-win for everybody,” Jorde said.
Strict Eligibility Requirements
To meet eligibility requirements, recipients’ HIV must be perfectly controlled, Jorde said. The virus must be undetectable, and the recipient must meet criteria for heart transplantation as well. Willing recipients go on the general heart transplant waiting list.
“This has been done for liver and kidney transplantation. It has never been done for a heart transplant patient,” Jorde said.
The reason the innovation has come later for hearts, he said, is that the margin of error with heart transplant is extremely narrow.
“If you have a heart transplant and have a severe rejection, you may die. If you have a kidney transplant and you have a severe rejection, you go back on dialysis,” he explained.
You also have to have the right patient, he noted.
The patient has to be willing to take the risk of being part of something that has never been done and have exceptional trust in his or her doctor.
“The true pioneer and the true hero here is not me, not the surgeon who put it in, it’s the patient. The patient has said, ‘I want to live. I trust you. I’m willing to take this risk,’ ” Jorde said.
Confidence Has Grown Over the Years
Confidence in transplanting an HIV-positive heart into an HIV-positive recipient has grown over the years. There is long-term evidence of success with HIV-positive liver and kidney donors, and there have been improvements in medications to suppress HIV.
Dr Julie Doberne
Julie Doberne, MD, PhD, with the Department of Cardiovascular and Thoracic Surgery, Duke University, in Durham, North Carolina, has researched survival outcomes of heart transplantation for HIV-positive recipients in comparison with outcomes for HIV-negative recipients.
She said about the announcement, “This is an important advancement in the fields of organ transplantation, HIV care, and advanced heart failure. Heart transplantation remains the gold standard for end-stage heart failure treatment. Hundreds of people with heart failure die each year waiting for a heart.
“Research from the abdominal transplant literature shows that HIV-positive donor to HIV-positive recipient transplantation is safe, and this first HIV-positive donor to HIV-positive recipient heart transplant may herald an increase in organ availability for heart failure patients living with HIV in the future,” she said.
However, she said she would not expect a sudden increase in these transplants.
She pointed out that “there are rigorous stipulations in the HOPE Act that limit heart transplant centers from participating in HIV-positive donor organ transplantation.”
One of the criteria, she says, relates to the number of transplants that the center has done in which the donor is HIV negative and the recipient is HIV positive.
“Since very few centers have sufficient volume to overcome this requirement, only two centers in the US [Montefiore and New York-Prebsyterian/Columbia] are currently allowed to list patients for HIV-positive donor/HIV-positive recipient heart transplantation. It is a lengthy process to become qualified.”
Jorde and Doberne have disclosed no relevant financial relationships.
Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune, Science News, and Nurse.com, and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick.
For more news, follow Medscape on Facebook, Twitter, Instagram, and YouTube.