For the first time, a person living with human immunodeficiency virus (HIV) has received a lung transplant from a donor who is also HIV-positive. This feat could open the door to more transplants for people living with HIV and end-stage organ disease.
On March 21, Bertrand Nelson, a 56-year-old New Jersey man who has lived with HIV for more than 20 years, received a double lung and liver transplant from a deceased donor who was also HIV-positive. The surgery was successful and Nelson was discharged and returned home a few weeks ago.
Nelson says he is happy to have received the transplant, especially because he wants to fight against the stigmatization suffered by people living with HIV. HIV-positive people need to know that they are eligible as organ donors and could potentially save the lives of one or more people, he says. And for people living with HIV who need a transplant, his message is: “You are worthy.”
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He also feels gratitude to his donor and his family. “Those of us who are recipients, we never forget the giver,” he says.
People with HIV live longer thanks to medications that effectively suppress the virus to undetectable levels in the body. In turn, they are also increasingly likely to develop age-related health problems, such as end-stage heart or lung disease. As a result, there is a growing need for organ transplants among people living with HIV.
“This is an important milestone for several reasons,” says Sapna Mehta, clinical director of the NYU Langone Transplant Institute and co-architect of the research protocol that allowed Nelson to obtain his lung transplant. “This truly demonstrates how far we have come in the care of HIV-positive patients. They live a long time and can be organ donors.”
The procedure, performed by surgeons at NYU Langone Health in New York, was made possible thanks to HIV Organ Policy Equity (HOPE) Act. Passed in 2013 under President Barack Obama, the law allows people with HIV to donate their organs to other infected people. Previously, organ transplantation into an HIV-positive person was a federal crime.
Since the program began, people living with HIV have been able to receive kidneys or livers from HIV-positive donors, but until 2024, these surgeries were performed as part of a research program and required approval from an independent review committee. Under the Biden administration, the Department of Health and Human Services changed this rulethus allowing kidney and liver transplants from HIV-positive donors outside of research. But heart and lung transplants are still considered too experimental.
The lung transplant at NYU Langone is the world’s first lung transplant from an HIV-positive donor to an HIV-positive recipient. HIV-positive recipients could already receive organs from HIV-negative donors, but this advance paves the way for a new supply of potentially transplantable organs at a time when organs are seriously scarce.
Nelson was diagnosed with HIV and sarcoidosis in 2000. Sarcoidosis causes pockets of immune cells to build up throughout the body, particularly in the lungs. After Nelson received treatment for the disease, his sarcoidosis went into remission for 20 years. But in 2021, he found himself with Legionnaire’s diseasea serious form of pneumonia caused by Legionella bacteria. This reactivated his sarcoidosis and his lung function declined rapidly. He was put on oxygen, and by fall 2024, he needed a lung transplant.
After being turned down by a transplant program in Pennsylvania, Nelson contacted NYU Langone, where he began the arduous process of being evaluated for placement on the transplant list. He was placed on the list on October 2, 2024. And a few months later, he received a call that a pair of lungs and a liver were available.
On the operating table, Nelson went into respiratory arrest. “They lost me on the table,” he said. But doctors revived him and he spent 67 days in the hospital before sending him home to New Jersey, where his 81-year-old mother cared for him with the help of a cousin.
“My mother is such a strong woman,” Nelson says. “He’s a really cool cat.” In 2017, she took care of her brother after a kidney transplant, so she has a lot of experience caring for someone after a transplant, he says.
As for Nelson, he says he is doing well mentally, although he is still weak after spending so long in the hospital. He hopes to start physical therapy soon.
Editor’s note (06/19/26): This article has been updated to correct a detail about Bertrand Nelson’s operation.
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