Doctors at a New York City hospital performed the world’s first successful heart transplant between an HIV-positive donor and an HIV-positive recipient, according to a press statement from Montefiore Health System in the Bronx, where the surgery took place this spring.

The recipient, a woman in her sixties who had advanced heart failure, also received a simultaneous kidney transplant. The life-saving four-hour operation took place this spring, and the recipient stayed in the hospital for five weeks while recovering.

“Thanks to significant medical advances, people living with HIV are able to control the disease so well that they can now save the lives of other people living with this condition,” said Ulrich P. Jorde, MD, a heart transplant specialist at Montefiore and professor of medicine at Einstein College of Medicine, in the press release. “This surgery is a milestone in the history of organ donation and offers new hope to people who once had nowhere to turn.”

The groundbreaking transplant took place nearly a decade after the HIV Organ Policy Equity (HOPE) Act was passed by Congress and signed by then-president Barack Obama in 2013. Before that, transplants between two HIV-positive people were illegal.

The first HIV-to-HIV transplant didn’t take place until 2016, when Johns Hopkins Medical Center in Baltimore performed the nation’s first organ transplants (a kidney and liver) from an HIV-positive donor to HIV-positive recipients. These two transplants, like most after them, involved a deceased HIV-positive donor.

In 2019, Nina Martinez, a 36-year-old Atlanta woman who had contracted HIV from a blood transfusion as a newborn, became the first living HIV-positive kidney donor.

The wait times for heart transplants are long—often more than half a year, reports Bronx Times—and the transplanted heart can’t be placed in cold storage for more than four to six hours.

The heart transplant recipient in Montefiore had been on a wait list “for quite a bit of time,” her cardiologist, Omar Saeed, MD, an assistant professor of medicine at Einstein, told Bronx Times. So to increase her chances of finding a donor, Saeed and the medical team brought up the possibility of receiving a transplant from another person with HIV. “She was really completely fine with [that] and accepted the risks and benefits and signed consent,” Saeed said, adding: “This is a major accomplishment for us. But for me, I am in awe of her bravery, and I’m just amazed by her strength.”

Montefiore is one of 25 medical centers in the United States able to offer surgeries like this one.

“The goal of the Montefiore heart transplant team is to constantly push and establish new standards so that anyone who is appropriate for an organ transplant can benefit from this life-saving procedure,” added Daniel Goldstein, MD, professor and cardiothoracic surgery specialist at Montefiore and Albert Einstein College of Medicine.

“This was a complicated case and a true multidisciplinary effort by cardiology, surgery, nephrology, infectious disease, critical care and immunology,” added Saeed. “Making this option available to people living with HIV expands the pool of donors and means more people, with or without HIV, will have quicker access to a lifesaving organ. To say we are proud of what this means for our patients and the medical community at large is an understatement.”

In the United States, between 60,000 and 100,000 people could benefit from a new heart, according to Montefiore. However, only around 3,800 transplants were performed in 2021.

In related news, the federal government revised guidelines for organ transplants in June 2020 that could result in more organ donations. Notably, the update included new criteria for identifying donors with potentially undetected HIV and hepatitis B and C viruses (HBV and HCV). Thanks in part to advances in testing and treatment, more organs can now be accepted from people who would have been classified as an increased risk donor.