At the end of last year, a team of specialists from Universiti Malaya Medical Centre performed a kidney transplant on a HIV patient.
It was the first time in Malaysian history that such a procedure was done on a person living with HIV.
Six months have since passed and the patient is now living a healthy life. The transplant has thus been hailed as a resounding success.
To learn more about the operation, FMT Lifestyle spoke to three representatives from the medical team behind it. These were Dr Lim Soo Kun, a nephrologist and UMMC’s renal division head; Dr Shanggar Kuppusamy, a urologist; and Dr Raja Iskandar Shah Raja Azwa, an infectious disease expert.
They referred to the patient as Mr C. “He was a man in his 50s who was diagnosed with HIV 20 years ago,” Lim said.
Mr C experienced kidney failure two years ago. Normally, people with kidney problems can undergo dialysis at medical centres. However, many dialysis centres turned him away because of his HIV status.
“There are very limited dialysis facilities which accept HIV patients,” said Lim.
Left with few options, Mr C explored the possibility of receiving an organ transplant. Apparently, he consulted more than 20 local and foreign doctors.
“Somehow, he was told it was not possible because of his condition,” Lim said. “He never gave up and he came to us and asked about the possibility of UMMC doing the transplant.”
Such a procedure had never been done in Malaysia, but it had already been successfully performed overseas.
Finding a donor was not an issue as Mr C’s wife had volunteered and one of her kidneys currently resides in him.
Raja Iskandar, who is the Malaysian AIDS Council president, said Mr C’s trouble of having to first go through 20 other doctors was a sign that “people are generally used to the status quo and don’t want to challenge it.”
He said the stigma caused by the HIV/AIDS scare of the 1980s was still evident in Malaysia and a misplaced moral judgement was causing HIV patients to be unfairly treated by some medical practitioners.
“Because of the inherent prejudices and stigma, we tend to be overly cautious when we don’t necessarily have to be.”
Shanggar said: “The key point here is discrimination. We don’t want to discriminate against anybody who has an infectious condition. We, as surgeons, should not discriminate against them and we here at UMMC were happy to do the procedure.”
He said the procedure involved two concurrent operations, one on Mr C and the other on his wife. “The precautions taken were ordinary.”
According to Lim, one thing that medical practitioners should consider is the equation of “Undetectable = Untransmittable”.
“If you can’t detect the virus in the patient’s blood, it means the patient cannot transmit the infection to others,” he said. “The risk of transmission is almost equivalent to zero.”
UMMC proceeded with the operation because Mr C had an undetectable viral load and was in good health.
There were some fears that Mr C’s body would reject the new organ, a possibility in any transplant case.
All transplant recipients are given anti-rejection medicine, which suppresses the immune system and allows the new organ to remain accepted.
Suppressing a HIV patient’s immune system seemed risky, however. “If you suppress it insufficiently, the body rejects the organ,” Lim said. “If you suppress it excessively, the body will be vulnerable to infections.”
In Mr C’s case, though, he had been undergoing constant HIV treatment. So his immune system was in relatively good shape.
After several hours of work in the operating theatre, the medical team watched in relief as the transplanted kidney worked without issue.
So, what does this mean for the future? “It’s a big win against stigma,” said Raja Iskandar. “There’s no longer any reason why a HIV patient should not be given the same opportunities for healthcare.”
Shanggar said: “There has been a lot of progress made in HIV treatment. We should move on from discriminating against patients.”
Lim said he hoped NGO-run dialysis centres would now begin to accept HIV patients. – FMT