South Africa is renowned for medical breakthroughs and medical pioneers.
We all know about the first heart transplant by Dr. Chris Barnard in 1967, but the country can also lay claim to performing the world’s first bilateral sequential lung transplant, the world’s first non-surgical closure of a leaking heart valve, the first successful penis transplant, and recently the world’s first successful liver transplant from an HIV-positive mother to her critically ill HIV-negative child. The beauty of this particular story is that a year after the surgery, the child shows no signs of having acquired HIV.
Last year, doctors at the Wits Donald Gordon Medical Centre were facing a conundrum. A baby had been on the waiting list for a liver transplant for 180 days, and they were running out of options. She was getting sicker by the day.
The mother, who was doing well on HIV treatment, contacted the doctors and pleaded with them to take part of her liver so that her child could live.
Dr. June Fabian, from the Centre’s research office says the mom was adamant.
“She approached us saying – I’m well, my child is going to die, why you can’t take a portion of my liver – and that is when we started asking ourselves whether there was a good reason NOT to do it.”
Fabian says there is always the risk of transmission, but the mother was doing very well on anti-retroviral drugs, and had an undetectable viral load.
She says the mom was also very well informed, having done her own research.
“The mom basically told us – If I can live really well with HIV, and my child gets HIV from this transplant, it’s something I can live with, because my child will still be alive.”
The night before the transplant, the infant was given a combination of three antiretroviral drugs to help prevent HIV infection from the donated liver. The good news is that a year after the operation, there is no evidence of HIV in the child’s blood, although doctors will continue to monitor her over the next two years at least.
Fabian says more great news is that this now opens up the pool of possible donors, because HIV positive people had historically been excluded.
She says there are about 4 million people who are living very well with HIV, taking one tablet per day to suppress the virus, and they might now be able to help their children if they get sick.
It’s a small step, but hopefully more people will in future be able to donate life saving organs.