Historically, people living with HIV have been banned from donating organs over possibilities that the virus could be transmitted through a donated issue.
But a South African mother recently pleaded with doctors at the Wits Donald Gordon Medical Centre in Johannesburg to re-examine the above and has since made the hospital the first in the world to transplant a liver from an HIV-positive donor to an HIV-negative child.
The HIV-infected mother had watched her baby with end-stage liver disease deteriorate while waiting for a liver transplant for 180 days.
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The woman would have been able to transplant a portion of her liver to her child had she not been infected with HIV.
“Why are you excluding me just because I’m HIV positive?” Transplant surgeon Jean Botha remembers the woman saying.
“We were under the presumption going into this that the child would develop HIV. That was the ethical debate: We had to balance the benefit of saving the child’s life against the risk of [contracting] HIV,” he told journalists at a press conference.
“We know now that people living with HIV can live healthy lives on antiretrovirals. We were hoping that even if the child developed HIV, that we’d have given the baby the ability to live a normal childhood and adolescence and in adulthood make decisions regarding the disease.”
The doctors added that they had to look at the ethical implications as well.
“We were also faced with the risk to this child, having a child who was too young to tell us if they were willing to assume that risk,” Harriet Etheredge, a medical bioethicist who worked on the case said, adding that investigation is ongoing to determine the girl’s HIV status.
Before the historic operation, the team of doctors monitored the mother to ensure that her CD4 count, the white blood cells that fight infection was at acceptable levels.
Her HIV viral load had been suppressed for six months before donation, and only part of her liver was used for the operation, according to reports by the CNN.
The baby was given three antiretroviral drugs the night before the surgery to prevent HIV transmission while an anti-inflammatory was administered during the operation.
The doctors say that both mother and baby are doing well and the child remains HIV-negative though they will still do follow-up checks on them.
South Africa has previously chalked successes in transplants between people with HIV but what makes this operation different is the fact that it is the first liver donation from a living HIV-positive donor in the country as previous donors were deceased.
It is also the first liver transplant from an infected donor to an HIV-negative recipient, with the aim to reduce transmission in the recipient.
This shows that living HIV-positive patients can safely donate organs, and this is a relief for South Africa that has a severe shortage of organ donors. Being one of the African countries with a high rate of HIV, the surgery implies that those affected can also provide more transplants to save lives.
This is the second time South Africa has made a major surgical feat after doctors of the Stellenbosch University (SU) and the Tygerberg Academic Hospital in Cape Town performed the world’s first penis transplant in 2014.
The same team performed the world’s third surgery in 2017 on a 40-year-old recipient who was reported to have lost his penis 17 years ago due to complications after traditional circumcision.