SF surgeon seeks law fix to do transplant from HIV-infected donor
By Melody Gutierrez
SACRAMENTO — A San Francisco surgeon preparing to perform a life-saving liver transplant from an HIV-positive donor to an HIV-positive patient ran up against an unexpected problem this month. The procedure, although allowed under federal law, is illegal in California.
On Wednesday, UCSF transplant surgeon Peter Stock stood before a group of lawmakers at the state Capitol and pleaded for an immediate law change that would allow him to try to save his patient’s life. And legislators are rushing to fix the California law this week in hopes that the change comes before it’s too late.
“We had been given the green light to proceed less than a month ago from the institutional review board,” Stock told The Chronicle. “Everything came to a halt when we found out it’s still illegal in California.”
SB1408 would delete a provision in California law that makes it a crime — punishable by up to six years in prison — for a person with HIV or AIDS to donate blood or organs under any circumstance, even if it is to help a person already infected with the virus. The bill would allow transplants from HIV-positive donors to HIV-positive recipients and ensures the state Medical Board can’t penalize doctors for conducting such procedures.
Stock described his patient, whom he called “Patient A,” as a man who is “quite ill” with a failing liver and other serious conditions. A living donor with HIV wants to donate part of his liver to save the patient. But Stock said Patient A may become too ill in the coming weeks to receive a liver transplant if lawmakers don’t act fast. He said there is also another HIV-infected patient awaiting a liver transplant who “suffers from recurring infections that are life-threatening and can cause death within hours.”
State Sen. Ben Allen, D-Santa Monica, said he hopes to bring the bill for a vote in both the Assembly and state Senate on Friday. SB1408 has an urgency clause that requires a two-thirds vote in both houses so that if passed by the Legislature and signed by Gov. Jerry Brown, the law would immediately go into effect.
Seeking quick action
“We’re hoping to have the governor sign it this weekend,” Allen said. “We are hopeful to get it through in time to do this transplant to save a life and then save more lives.”
Stock said Wednesday that every day that passes increases the chance that his patient will become too ill to receive the liver transplant. If performed, the surgery would be the first known transplant from a living HIV donor to an HIV patient, Stock said.
The bill has the support of both the Democratic and Republican leadership and passed the Assembly Health Committee on Wednesday on a bipartisan 14-0 vote. Attorney General Kamala Harris sent a letter urging lawmakers to include the urgency clause after hearing from the University of California regarding the patient at UCSF.
“This is about saving lives,” said Assembly Republican Leader Chad Mayes of Yucca Valley (San Bernardino County). “We shouldn’t let parliamentary procedure get in the way.”
The law was enacted nearly three decades ago when very little was known about HIV and AIDS.
San Francisco Assemblyman David Chiu said Wednesday at the Assembly Health Committee that the ban in California stems from “homophobia and hate mongering from the 1980s” and needs to be overturned.
In 2013, President Obama signed the federal Hope Act, which repealed a 1988 U.S. ban on organ donation from HIV-positive people in order to allow scientists to research organ donation from donors with HIV to patients with HIV. At the time, Obama said the ban was outdated.
Guidelines for transplants from HIV-positive donors under the Hope Act were approved last year, and doctors began moving forward with the procedures this year.
In March, Johns Hopkins University School of Medicine became the first hospital in the world to perform a transplant from a deceased HIV-positive liver donor to an HIV-positive patient.
UCSF is one of four hospitals in the country that meets criteria to perform the transplants using HIV donors, and the hospital has 65 HIV-positive patients waiting for kidneys or livers.
Doctors say repealing the law in California will benefit all transplant patients by allowing people with the virus to receive transplants from other HIV-positive donors, thus freeing up a spot on the lengthy waiting lists for people who don’t have HIV.
Of the 123,000 people waiting for an organ transplant across the nation, 22,000 are in California, and most of those need a kidney. Last year, doctors in California performed 3,000 transplants, while 1,100 people died in California waiting for an organ, said Monica Johnson, board chair of Donate Life California, which supports SB1408.
In San Francisco, 715 people are waiting for an organ donation, and in Alameda County, 1,433 people are on the list. For people with HIV on the waiting list, the ability to receive donations from HIV-infected donors could drastically shorten their waiting time.
In 2011, a study found about 500 HIV-positive people die in the United States each year from non-virus-related causes, which means their organs could be eligible for donation.
“What we have heard from bereaved families is one of the most important aspects of this law — it allows their deceased loved ones to provide a legacy so they can still give rather than be remembered as a disease with a fair amount of stigma,” said Nikole Neidlinger, chief medical officer for Donor Network West and a transplant surgeon in San Francisco.
California is one of 17 states with laws prohibiting HIV-positive organ donations and transplants. The laws, like the repealed federal ban, were in place to protect uninfected people from becoming infected via blood or tissue donation.
Doctors said that the idea that HIV-positive organ donors could help HIV-positive patients was initially overlooked because patients infected with the AIDS virus were not expected to live long.
But antiretroviral drugs have significantly prolonged the lives of men and women living with the virus, leaving some suffering from kidney and liver damage. Doctors have successfully performed organ transplants from virus-free donors to HIV-positive patients for more than 15 years.
“We are losing a lot of people every day,” Stock said. “For that reason, any donor we have that has the potential for several organs is saving lives.”