Date: Tuesday, June 4, 2019
Session Name: Concurrent Session: Kidney Living Donor: Selection
Session Time: 4:30pm-6:00pm
Presentation Time: 4:30pm-4:42pm
Location: Ballroom A
*Purpose: Living donation (LD) has been allowed under the HOPE Act since 2013, yet to date there have been no HIV+ LD organ transplants performed in the U.S. Knowledge gaps still exist in the HIV and medical community surrounding donation and unique ethical and medical challenges exist.
Our center has identified ways to spread awareness for LD and develop an active HIV+ LD kidney program. We sought IRB approval and UNOS variance 1yr ago, affording time to begin exploring educational opportunities within the HIV+ community. To date, we have identified 3 different HIV+ living donors, with 3 different viable routes to transplant.
*Methods: A critical review of our current LD practices was performed. The following aspects were considered: (1) How do we spread awareness of LD for people living with HIV (PLHIV), while maintaining high ethical standards? (2) What are the possible legal and medical pathways by which PLHIV could donate? (3) What operational changes are required within our center to ensure success? (4) What medical differences should be considered for an HIV+ living donor?
*Results: Our current transplant center protocols were adapted to meet the unique needs of PLHIV according to HOPE. Strategies were developed to expand this new LD pool, resulting in growth of the donation program. Specifically: (1) HIV clinicians now introduce living donation to potential donor candidates earlier; (2) Education classes expanded to include options for PLHIV to donate; (3) Outreach evenings to nephrology and HIV providers now include education regarding how to embrace a donor population that had historically been excluded; (4) HIV+ recipients volunteer to mentor and speak in public venues about LD.
Furthermore, 3 key pathways to LD in PLHIV were identified and tested: Non-directed donation: A PLHIV approached our center to discuss donation as a result of seeing a news segment discussing local HOPE Act patients. A multi-disciplinary team continues to evaluate him, for possible D+/R+ donation, to someone at our center or beyond. Directed donation: A potential HIV+ donor, the partner of an HIV+ candidate, approached our center for evaluation. Additional testing and appointments required by the HOPE Act led to medical and ethical concerns, and ultimately, D-/R+ transplant occurred. Paired kidney exchange: A PLHIV requested evaluation in 2018, as potential participant in our Kidney Paired Donation (KPD) program. The intended recipient (wife) remains HIV-, so our team agreed that we would process this pair as any other facing an incompatibility. Evaluation is ongoing.
In each case, unique ethical challenges occurred, and modeling future renal function decline in the potential donor remained challenging.
*Conclusions: As our experience grows and our broader community becomes increasingly aware of the options for HIV+ LD, we believe we have created viable, safe and efficient pathways to transplant. Future research will focus on evaluation of these pathways, message penetration into the HIV+ community, donor selection, and transplant outcomes.
To cite this abstract in AMA style:Rusch S, Fieldman L, Hemmersbach-Miller M, Wolfe CR. Opening the Doors of Hope: HIV-Positive Living Kidney Donation [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/opening-the-doors-of-hope-hiv-positive-living-kidney-donation/. Accessed November 24, 2020.
« Back to 2019 American Transplant Congress