17 October 2018

Innovative organ transplant procedure at the teaching hospital of the University of the Witwatersrand

The United Nations Academic Impact (UNAI), as part of its continuous outreach efforts about the 2030 Agenda for Sustainable Development and the Sustainable Development Goals (SDGs), shares this story related to Goal 3: Ensure healthy lives and promote well-being for all at all ages, submitted by the University of the Witwatersrand, a UNAI member institution located in South Africa. The article was drafted by Doctor Harriet Etheredge, Doctor June Fabian and Professor Jean Botha.

17 October 2018 - The University of the Witwatersrand (South Africa), a member institution of the United Nations Academic Impact (UNAI), and in particular the Wits Donald Gordon Medical Centre performed the world’s first living donor liver transplant from an HIV positive mother to her HIV negative child. The multi-disciplinary team of the university took a careful and thorough deliberation to arrive at the decision to do this procedure, bearing in mind the basic principles of organ donation, which are universal. 

Transplantation is defined here as "the transfer (engraftment) of human cells, tissues or organs from a donor to a recipient with the aim of restoring function(s) in the body". Worth to remember that the World Health Assembly in its 63rd session said through resolution 63.22 that "the voluntary, non-remunerated donation of organs, cells and tissues from deceased and living donors helps to ensure a vital community resource". The resolution also endorsed the Guiding Principles on Human Cell, Tissue and Organ Transplantation.

Such Guiding Principles were issued by the World Health Organization, a specialized agency of the United Nations. And while there are two types of organ donors, “deceased donors” and "living donors", doctors usually prefer to use organs from deceased ones since that kind of surgery for a living donor carries a significant risk for someone who is perfectly healthy. That said, in South Africa like in many parts of the world, it is not always possible to help people with organ failure due to the serious shortage of deceased donor organs. 

Although kidney transplants from living donors are quite common, liver transplants from living donors are much less so. In a particular and unique case, the Wits Donald Gordon Medical Centre had a child who was critically ill with liver failure from a condition that was present at birth, and had nothing to do with the pregnancy or the mother’s HIV status. The mother knew her HIV positive status and she took antiretroviral therapy during her pregnancy to prevent infecting her baby. The baby also received antiretroviral therapy after birth to prevent infection, and for a while was on the waiting list for a deceased donor but over time the child became severely ill.

At the same time, the child’s mother asked to consider her as a living donor but this kind of transplant has never been done before, so the team had to ensure it was done in a very controlled way. This means that the multi-disciplinary team had to check that the mother had no HIV circulating in her blood at the time of the operation, and they were able to start the child on antiretroviral therapy before the actual procedure. It is now more than a year since the operation and both mother and child are alive and thriving, something that represents a huge medical success for the Transplant Unit of the Wits Donald Gordon Medical Centre.

Furthermore, even with very sophisticated testing, the team has not been able to find any evidence of HIV infection in the blood of the child. Sometimes, the children of HIV positive parents also get end-stage liver failure unrelated to HIV, and their children need transplants. “Why not consider these parents as donors?”, the specialists asked. Although this is only one case, the team was able to show that this kind of transplant is indeed quite possible and it certainly opens up a new era of transplantation in South Africa, a country with one of the largest antiretroviral treatment programmes in the world.