HIV-Positive Mother Donates Liver to Uninfected Daughter
An HIV-positive woman has donated a part of her liver to her 13-month old daughter, the first time such a transplant has been performed between an infected donor and an uninfected patient.
Doctors at the Wits Donald Gordon Medical Centre in Johannesburg, South Africa, recently announced the success of the surgery, which was performed last year. According to a paper on the procedure, the mother and daughter are doing well and the daughter remains HIV-negative.
The child, who had been suffering from end-stage liver disease, had undergone a previous surgery and was placed on the list for a deceased-donor liver. Her mother asked to be considered as a donor, since only part of the liver is needed for a transplant.
Despite the request, the hospital has a policy that does not allow HIV-positive living donations. Two other family members were evaluated for donation, but they were not suitable, according to the paper published in the journal AIDS. Because of the child’s “deteriorating health,” the doctors became “concerned that without transplantation death was imminent.”
Jean Botha, the program’s director and lead surgeon, told CNN that the team was “faced with a tough decision.”
“We had to choose between the death of the child and accepting an infected organ to save her. The mother kept pushing and almost challenged us that we were possibly discriminating against her. Knowing HIV individuals live healthy lives, we had to take the opportunity,” Botha said.
Harriet Etheredge, a medical bioethicist on the team, told CNN there were also numerous ethical implications.
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“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,” Etheredge said.
After three months on the donor list, the situation was “carefully thought-through from both legal and ethical perspectives” and the procedure was approved as a pilot study. The child was given several antiretroviral drugs prior to the transplant to prevent the transmission of HIV.
The team believes the operation opens the possibility to increase the number of living donors in places where rates of HIV are high and a shortage of deceased donors exists.
“This case potentially opens up a new living liver donor pool,” the paper states, “which might have clinical relevance in countries where there is a high burden of HIV and a limited number of deceased donor organs or limited access to transplantation.”