Surgeons at Johns Hopkins Hospital have transplanted a kidney from a living HIV-positive donor to an HIV-positive recipient, a medical breakthrough they hope will expand the pool of available organs and help change perceptions of HIV.
The procedure is another step in the evolution of HIV — considered to mean certain death when the AIDS epidemic began in 1981 — and an advance for the 1.1 million people who carry the virus. Medication today can suppress the infection to undetectable levels in many people, and President Trump recently vowed to end transmission of it in the United States by 2030. But stigma still remains.
“Society perceives me, and people like me, as people who bring death,” Martinez said in an interview Saturday before the operation. “And I can’t figure out any better way to show that people like me can bring life.”
Martinez, who acquired HIV from a blood transfusion as an infant, appeared at a Hopkins news conference Thursday to announce the surgery, the first of its kind. She said she feels well and is looking forward to training to run in this October’s Marine Corps Marathon in Washington.
“People with HIV today can’t donate blood, but now they’re able to donate a kidney,” said Dorry Segev, a professor of surgery at the Johns Hopkins University School of Medicine, who led the research team and removed Martinez’s left kidney. “They have a disease that 30 years ago was a death sentence. Today, they’re so healthy they can give someone else life.”
Surgeons have transplanted 116 organs from deceased HIV-positive donors to recipients with HIV since 2016, when a new law allowing that surgery took effect. Among people without HIV, more than 152,000 kidneys from living donors have been transplanted over the past 30 years, and a few hundred livers from live donors are implanted each year.
More than 113,000 people are on the U.S. waiting list for organ transplants, most of them seeking kidneys. Others are too sick to be listed, or are taken off the list when their disease progresses too far.
Until now, leaving an HIV-positive person with just one kidney was considered too dangerous because the infection and the medications that control it increase the chances of kidney disease.
But a 2017 study of 42,000 people led by Hopkins researchers showed that for some healthy HIV-positive donors, the risk of developing serious kidney disease is not much greater than it is for many HIV-negative people, especially those who engage in behaviors such as smoking.
Martinez’s organ was implanted in the recipient by a separate team of surgeons, the normal procedure in transplantation. The operation was performed by Niraj Desai, an assistant professor of surgery at Hopkins.
The kidney was implanted near the recipient’s pelvis through a six- to eight-inch incision in the abdomen, and the recipient’s kidneys were not removed, as is common practice, Desai said. Kidney recipients can expect 20 to 40 years from a transplanted kidney, Segev said, with those who receive live kidney donations doing a little better than those who get the organs from deceased donors. After that period, the recipient would require another transplant or go back on dialysis, he said.
Martinez and the recipient will remain on antiretroviral medication indefinitely to control their HIV. Because they may have different strains of the virus and different resistance to HIV medication, doctors must monitor the recipient closely in the months after the donor organ is introduced. The recipient will also take drugs to prevent organ rejection. Those are not expected to significantly interfere with the HIV-suppressing medications.
Martinez is in near-normal physical health. Her viral load is undetectable. “Her health is excellent. Her HIV is well-controlled. Her immune system is essentially normal,” said Christine Durand, an associate professor of medicine at Hopkins and a member of the team that evaluated Martinez.
In 1983, Martinez and her twin sister were born 12 weeks prematurely in San Jose and soon developed anemia. The daughter of a naval officer, Martinez was taken to a military hospital in San Francisco for a blood transfusion in the days before the supply was tested for HIV, and she acquired the infection. She and her family were not aware of it until she was checked before eye surgery at the age of 8.
She was watched in school to ensure she wasn’t a health hazard to other children, she said. She later learned that one principal asked, “Why are we educating her with public dollars if she’s going to die?”
When a housemate found out she had HIV, he moved out, leaving his belongings behind.
“It gives me great joy to know that I’m putting a story like this out there,” she said. “Because those people need a mental reboot.”
A public health consultant who lives in Atlanta, Martinez was aware of the HIV Organ Policy Equity Act, the law allowing the surgery, when it was passed in 2013. The next year, she saw an episode of the television show “Grey’s Anatomy” in which the writers invented a story about a transplant from a live, HIV-positive donor.
When an HIV-positive friend needed a kidney, Martinez grew more serious about the idea and contacted Hopkins to volunteer for the grueling test regimen that enabled her to become the first donor in its clinical trial. But Martinez’s friend died before she could donate to him.
She believes her choice will ripple down the transplant waiting list.
“When I take this recipient off the list, everyone moves up,” she said, “whether they have HIV or not.”