Vall d’Hebron performs Spain’s first transplant between two people with HIV

Two middle-aged men have been involved in Spain’s first organ transplant between two people with HIV. The recipient had chronic glomerulonephritis, unrelated to HIV, which progressed to the point where he required a kidney transplant. Vall d’Hebron University Hospital, a leading centre for transplantation and infectious diseases, performed the procedure: a living-donor kidney transplant carried out using robotic surgery. Combined antiretroviral therapy (ART) has transformed HIV infection into a treatable chronic condition, with life expectancy close to that of the general population. As a result, people with HIV who are receiving treatment and have a suppressed viral load or good control of the virus experience health problems similar to those of the general population. 

“Vall d’Hebron is once again at the forefront: in 1981, we were the first hospital in Spain to diagnose a patient with HIV, and now, 45 years later, we have performed Spain’s first transplant between two people with HIV,” says Dr Albert Salazar, Managing Director of the Vall d’Hebron University Hospital. In Spain, the order authorising transplants between donors and recipients with HIV was approved in 2025, repealing previous regulations dating from 1987 that prohibited them. Since 2005, people with HIV in Spain have been eligible to receive transplants from donors without HIV, provided the recipient met a number of requirements, such as having an undetectable HIV viral load or one that could be suppressed with antiretroviral therapy, and having no history of opportunistic infections, except tuberculosis, oesophageal candidiasis or Pneumocystis jirovecii pneumonia.

“At the National Transplant Organisation (ONT), we have spearheaded the regulatory change that has made organ transplantation between people with HIV possible, together with a national protocol that ensures it is implemented safely and consistently. Our aim is not only to increase transplantation opportunities, but also to uphold the right of people with HIV to donate organs if they wish. I would like to congratulate Vall d’Hebron on this milestone for our transplant system and on turning into a clinical reality what scientific advances and the regulatory changes introduced now make possible,” says Beatriz Domínguez-Gil, Director General of the ONT.

“Performing Spain’s first transplant between people with HIV at Vall d’Hebron, after the regulatory restriction was removed last year, represents a medical milestone for the Hospital and will also help reduce waiting times for these patients: every year, around 50 people with HIV are waiting for an organ, 30 for a kidney transplant, 15 for a liver transplant, and five for heart, lung or pancreas transplants, according to ONT data,” explains Dr Albert Sandiumenge, Coordinator of Vall d’Hebron’s Donation and Transplantation Programmes.

“Thanks to antiretroviral treatment, well-controlled HIV infection is no longer an obstacle to successful transplantation between appropriately selected patients with HIV. Allowing people with HIV to become donors represents a major step forward in terms of rights, equality and inclusion for people living with HIV,” explains Dr Jordi Navarro, Deputy Head of the Infectious Diseases Department.

The first transplant between two people with HIV was performed in South Africa in 2008 and was a kidney transplant. Following the positive results, both in terms of patient survival and the absence of virological failure or opportunistic infections associated with acquired immunodeficiency syndrome (AIDS), other countries began to permit transplants between donors and recipients with HIV. In 2013, the United States passed the HOPE Act (HIV Organ Policy Equity Act), authorising such transplants as part of clinical studies. Since November 2024, kidney and liver transplants between people with HIV have formed part of routine clinical practice in the United States. Most Western European countries permit transplants between donors and recipients with HIV. In Europe, organ transplantation between people with HIV is expressly permitted in six countries, including Spain from 2025; prohibited in 11, and unregulated in 18. To date, only a limited number of transplants between people with HIV have been performed in European countries, mainly in Italy, the United Kingdom and France.

“Transplant outcomes in people with HIV are comparable to those in the general population thanks to advances in antiretroviral therapy, effective control of hepatitis C virus coinfection and the experience of specialist clinical teams,” notes Dr Francesc Josep Moreso, Section Head of the Kidney Transplant Unit, who was able to perform this transplant between two people with HIV following authorisation from the ONT made possible by the regulatory change. 

The Urology Department, led by Dr Enric Trilla, performed a planned procedure lasting four hours. “Living-donor kidney transplantation produces better outcomes than deceased-donor transplantation, including in people with HIV. Performing the transplant robotically has less physical impact on the patient than conventional surgery, as it reduces the risk of infection, supports postoperative recovery and carries a lower risk of abdominal wall complications,” explains Dr Enric Trilla, Head of the Urology Department. 

Vall d’Hebron is one of Spain’s leading transplant centres, having performed 387 transplants in 2025: 359 in adults and 28 in children. Of Vall d’Hebron’s solid-organ transplants, 185 were kidney transplants (40 living-donor and 28 robotic), 108 lung and 66 liver transplants in adults, and 13 liver, 10 kidney, 3 heart and 2 lung transplants in children and adolescents.