HIV-positive kidney donors are helping to save more lives

More than 90,000 Americans are currently on the United Network for Organ Sharing (UNOS) waiting list for a kidney transplant, and there aren't nearly enough donor organs to go around.

In New York State, the wait for a donor kidney is upward of seven years.

It is estimated that there could be as many as 2,000 HIV-positive donors in the United States — donors whose organs previously were not pursued because it was illegal.

Now, thanks to the passing of the Hope Act, many of these donors will be able to donate and save lives. We expect that this change in policy will bring about the largest increase to the pool of donor organs in the past 20 years.

At The Mount Sinai Hospital, where we recently performed the first transplant of an HIV-positive kidney to an HIV-positive recipient in New York State — and only the second in the nation — we currently have 90 people waiting for a kidney who are HIV positive, and already, more than 60 have given their consent to receive one from an HIV-positive donor.

For anyone (at our hospital and elsewhere) who is HIV positive and waiting for a kidney, this is fantastic news — they will be on the top of the list to receive from HIV-positive donors.

But it is also good news for everyone else who is waiting for a kidney, because it will cut down everyone's wait time.

Right now, the kidney shortage is severe enough that most patients still die waiting for a kidney. What leads someone to need a kidney transplant in the first place? In this country, kidney disease mostly results from complications of diabetes and high blood pressure.

As damage builds up, ultimately the kidneys fail, and the patient needs to go on dialysis. Dialysis uses a machine to replace the kidneys' function of filtering the blood, by removing both excess water and toxins.

But dialysis can only replace about 10% of the lost kidney function, and it is very time-consuming. Most patients receive dialysis at a treatment center three days a week, for four hours a day. And the risk of heart attack and mortality increases dramatically. Only 50% of patients on dialysis will be alive in four years.

A kidney transplant, on the other hand, has much better results than dialysis. To give you a sense of how effective transplant can be, Alonzo Mourning played in the National Basketball Association after getting a transplant, and the gold-medalist hurdler Aries Merritt will be competing in the Rio Olympics less than a year after receiving a kidney from his sister.

People can live and thrive with one functioning kidney, which is what gives us the option of living donors. On average, kidneys that come from deceased donors last seven years, while kidneys from living donors last 15-20 years.

We have been transplanting kidneys to patients with HIV for 15 years. Before that, it was thought that HIV-positive patients couldn't handle the immunosuppression that is required to keep the body from rejecting the transplant organ.

But actually, what we found was that the medicines that work against the HIV virus also helped the body accept the transplant.

Mount Sinai was one of the hospitals that participated in the five-year National Institutes of Health (NIH) trial that demonstrated that people with HIV can successfully receive transplants.

While these patients do have a higher risk of rejecting the kidney, we can manage this risk by using a higher dosage of the immunosuppressant drugs. The problem is figuring out exactly how much of which particular drug is right for an individual patient.

And post-transplant, patients must continue to take their HIV medications to keep their HIV under control.

After a transplant, all patients — whether HIV-positive or negative — need to trick their immune system so it doesn't attack the new organ as an enemy. We give a lot of immunosuppressant drugs at first, then we ratchet them down, and by the one-year mark, patients are on maintenance immunosuppression.

We monitor patients extremely closely throughout this time. People who have organ transplants will always need to be monitored; but the further out you get, the more your kidney adapts to your body. The one-year survival rate for kidney transplant is above 98%.

Kidney disease is one reason to go to the doctor every year. The signs and symptoms can be very subtle, including fatigue, weight loss or weight gain, and swelling.

The blood tests that are a standard part of an annual checkup usually include kidney function measures such as creatinine, blood urea nitrogen (BUN), and/or glomerular filtration rate (GFR).

These routine blood tests are the mechanism that first detects kidney problems for many patients. And if you go for a regular checkup, it's more likely we can catch this early.

For more information about kidney disease, check the National Kidney Foundation www.kidney.org and Mount Sinai www.mountsinai.org/patient-care/health-library/treatments-and-procedures/kidney-transplant.

For anyone who is HIV positive, the Hope Act is a wonderful thing. Thanks to this bipartisan act, thousands of HIV-positive organs can now be used instead of going to waste. And that is great news for everyone whose life depends on receiving an organ.

Sander S. Florman, MD, is the director of the Recanati/Miller Transplantation Institute, The Mount Sinai Hospital.