Harold Scott was the first patient at Vanderbilt Health to receive a transplant of an HIV-positive organ into a HIV-positive recipient. (photo by Erin O. Smith)
The Vanderbilt Transplant Center has completed its first transplant of an HIV-positive organ into an HIV-positive patient.
Harold Scott of Lebanon, Tennessee, received the kidney transplant from a deceased donor in July. He is doing well and wants to spread the word about this new frontier in organ transplantation and his Vanderbilt Health team.
“I couldn’t have asked for a better experience,” Scott said. “They took great care of me and still are.”
HIV, or human immunodeficiency virus, attacks the body’s immune system and causes AIDS, which was once a terminal illness. In the last three decades, thanks to a combination of prescription medicines, the virus can be reduced to undetectable levels, and patients with HIV can live normal lives.
Vanderbilt Health has adopted a protocol for transplanting HIV-positive kidneys and livers, said Maricar Malinis, MD, Associate Professor of Medicine and Medical Director of the Transplant Infectious Diseases Program. That followed the Department of Health and Human Services enacting a final rule in November 2024 authorizing kidney and liver transplants from donors with HIV to recipients with HIV as standard medical care.
After federal adoption of the HIV Organ Policy Equity (HOPE) Act in 2013, HIV-positive patients could participate in a clinical trial at other centers to receive HIV-positive organs. The trial proved that such transplants were safe and effective. Published data in the New England Journal of Medicine showed that patient survival, organ survival and rejection rates were similar whether the donated organ came from an HIV-positive or HIV-negative donor.
“That trial represents a large amount of comfort and safety for HIV-positive patients pursuing transplantation,” said Rachel Forbes, MD, MBA, Chief of the Division of Kidney and Pancreas Transplantation and Professor of Surgery.
Malinis said the use of HIV-positive organs not only ensures that HIV-positive patients can get an organ faster, but it also frees up HIV-negative organs for the HIV-negative population. Kidney failure patients can wait up to seven years for a deceased donor kidney to become available, but an HIV-positive organ could ensure qualifying patients get an organ much sooner.
“Our HIV-positive donors should be considered heroes,” Malinis said. “I think we should be at the point where we take away the stigma of being HIV-positive. It should be treated like a chronic disease like diabetes or hypertension, because like those diseases, we now have effective treatments.”
Heidi Schaefer, MD, Professor of Medicine and Medical Director of Adult Solid Organ Transplant, noted that Vanderbilt Health has been performing transplants of HIV-negative kidneys in HIV-positive patients since 2009 with excellent results. “We are excited about being able to expand access to transplantation for people living with HIV through the use of these organs,” she said.
Scott said he has lived with HIV for nearly 40 years, and prior to the transplant his HIV was not detectable thanks to medication. For the last 10 years, he has had chronic kidney disease, which resulted in kidney failure four years ago. During that time, doctors discovered cancer in his right kidney, which was removed.
Three years ago, he began dialysis and began waiting for a kidney to become available.
“There was a lot of fatigue after I would finish a treatment,” he said. “It kind of limited me as far as doing other things because I’d have to recuperate, and then it would be time for a treatment again.”
Scott tried all kinds of methods to get a kidney. He asked random motorists via a billboard on Interstate 40 near the Briley Parkway exit after the owners offered him a couple of billboards for free. Another went up on West End Avenue. Several people tested to see whether they would match to be a living donor, but that didn’t work out.
Scott also did extensive research of his own and pursued transplantation of an HIV-positive organ at Vanderbilt Health, bringing up the subject with Malinis. “I wasn’t concerned really at all,” Scott said.
Early in the morning July 5, Scott got the call he had been waiting three years for — that a matching kidney was available. Scott’s transplant was performed by B. John DuBray, MD, Assistant Professor of Clinical Surgery. The anesthesiology team included Meera Chandrashekar, MBBS, Assistant Professor of Clinical Anesthesiology, and Katrine Link, DNAP, CRNA.
“It was pretty exciting,” Scott said. “But it was kind of bittersweet for me, too, knowing that, of course, someone had died (for the organ to be available). So, in that regard, it’s been kind of sad, but I’m grateful to the donor and their family for making that decision.”
Malinis said Scott is doing well. His HIV is controlled, and he is tolerating his transplant medication. Scott said he’s looking forward to doing the things he’s had to miss out on for the last few years, such as traveling out West and being up in the mountains.
“I’m feeling great,” he said. “I’ve had to tweak my antirejection drugs a few times … but my numbers are really good. Just right in line where they need to be.
“Just lucky to have a second chance.”
