I am a 56-year-old man living with both diabetes and HIV. Recently, my doctor told me that my kidneys were failing and that I need to start getting dialysis. He mentioned that the ultimate cure for my kidney failure would be to get a transplant. He, however, was not too optimistic about my chances of getting a transplant due to my HIV status.
Please explain to me, does being HIV+ exclude me from getting a kidney transplant? What other treatment options do I have if I cannot get a transplant?
I have no living siblings and my parents are very elderly, can my friend donate their kidney? Can I get the transplant operation done locally?
First of all, being HIV positive does not disqualify you from getting a transplant. There are lots of successful kidney transplants involving HIV positive people.
When is HIV a limitation to transplant?
If you have advanced disease (medically known as stage 4 disease), you will not be an ideal candidate for transplant. People with stage 4 disease have very low immunity and are vulnerable to a myriad of life threatening infections and even cancer.
Ideally, HIV positive patients selected to receive kidney transplants need to have a strong immune system (despite the HIV) and very low number of viruses in their blood stream (ideally, have an undetectable viral load). They should also be adherent to their treatment and in good general form.
Who can donate a kidney to you?
You can receive a kidney from either a family member or from someone who is not related to you. Several tests are done to determine if your organs will ‘match’. These tests are done to try and see if your body will reject the kidney after the transplant. The donor of the kidney can either be living or deceased (usually organs from deceased donors are removed once they are pronounced ‘brain dead’ upon consent from the family).
Does the HIV status of the donor matter?
Yes, it does. Under normal circumstances, a HIV positive person cannot donate their organs to a HIV negative person. In your case, you can receive a kidney from both HIV negative and positive donors.
Can kidney failure be reversed?
No, unfortunately, it cannot. Once the kidney is destroyed, you cannot fix it. All you can try and do is prevent the kidney from deteriorating further. This means that you need to keep your diabetes under control. In addition, you must adhere to your anti-retroviral regimen and keep your immunity up. Find out if any of your drugs are contributing to your kidney failure, if they are, ask your doctor to change your medication.
Your doctor is also likely to start you on insulin injections in place of your anti-diabetes tablets. You also need to talk to a nutritionist to assess your diet and ensure that you are not engaging in bad food habits that may be harmful to your kidney. If you smoke cigarettes or use any tobacco products, you need to stop. Their toxins are harmful to your kidneys.
What are your options as you await a kidney transplant?
You will need to go for regular dialysis as your doctor suggested. You can either get hemodialysis or peritoneal dialysis. Hemodialysis is usually done two to three times a week. It involves passing your blood through a machine which cleanses it of all the waste. Each session lasts approximately four hours.
Peritoneal dialysis involves getting a special tube put into your abdomen. Through this tube, cleansing fluid is put into your belly. Once the tube has been inserted, peritoneal dialysis can be done from home.
Hemodialysis often requires you to go to hospital for each session. The decision on which mode of dialysis is best for you will be explained to you in depth by your doctor. We now have dialysis centres in almost every province in the country and you should be able to find a centre near you.
Are kidney transplants done locally?
Yes, you can get a kidney transplant done locally in both the private and public sector. NHIF and your private insurance health cover should be able to cover the cost of the procedure.
Kidney transplants need life-long medication
Often people imagine that once you get a kidney transplant, you are ‘completely cured’ and you can stop taking your medication. However, the truth is, once you have had a transplant, you will need to be on life-long medication to prevent your body from rejecting your ‘new’ kidney. You will need to continue taking your anti-diabetes and anti-retroviral drugs.