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Needs must: living donor liver transplantation from an HIV-positive mother to her HIV-negative child in Johannesburg, South Africa
  1. Harriet Rosanne Etheredge1,2,
  2. June Fabian3,4,
  3. Mary Duncan3,
  4. Francesca Conradie4,5,
  5. Caroline Tiemessen6,7,
  6. Jean Botha3,8
  1. 1 Wits University Donald Gordon Medical Centre, Johannesburg, Gauteng, South Africa
  2. 2 Internal Medicine, University of the Witwatersrand School of Social Sciences, Johannesburg, South Africa
  3. 3 Wits University Donald Gordon Medical Centre, Johannesburg, South Africa
  4. 4 Internal Medicine, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, Gauteng, South Africa
  5. 5 Clinical HIV Research Unit, Johannesburg, South Africa
  6. 6 Centre for HIV and STIs, National Institute for Communicable Diseases, Johannesburg, South Africa
  7. 7 University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
  8. 8 Surgery, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
  1. Correspondence to Dr Harriet Rosanne Etheredge, Wits University Donald Gordon Medical Centre, Johannesburg, Gauteng, South Africa; harriet.etheredge{at}mediclinic.co.za

Abstract

The world’s first living donor liver transplant from an HIV-positive mother to her HIV-negative child, performed by our team in Johannesburg, South Africa (SA) in 2017, was necessitated by disease profile and health system challenges. In our country, we have a major shortage of donor organs, which compels us to consider innovative solutions to save lives. Simultaneously, the transition of the HIV pandemic, from a death sentence to a chronic illness with excellent survival on treatment required us to rethink our policies regarding HIV infection and living donor liver transplantation . Although HIV infection in the donor is internationally considered an absolute contraindication for transplant to an HIV-negative recipient, there have been a very small number of unintentional transplants from HIV-positive deceased donors to HIV-negative recipients. These transplant recipients do well on antiretroviral medication and their graft survival is not compromised. We have had a number of HIV-positive parents in our setting express a desire to be living liver donors for their critically ill children. Declining these parents as living donors has become increasingly unjustifiable given the very small deceased donor pool in SA; and because many of these parents are virally suppressed and would otherwise fulfil our eligibility criteria as living donors. This paper discusses the evolution of HIV and transplantation in SA, highlights some of the primary ethical considerations for us when embarking on this case and considers the new ethical issues that have arisen since we undertook this transplant.

  • transplantation
  • HIV infection and aids
  • informed consent
  • surgery
  • regulation

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Footnotes

  • Contributors HRE: All drafts and ethics work on the project. JF: All drafts. MD: Transplant coordinator and draft checking. FC: Draft checking. CT: HIV sciences and draft checking. JB: PI and surgeon, all drafts.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval Human Research Ethics Committee (Medical), University of the Witwatersrand, Johannesburg.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no unpublished data relating to this study available.

  • Patient consent for publication Not required.

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