The HIV-positive patient who received Cedars-Sinai’s first HIV-positive donor kidney had previously been listed on the waitlist for more than two years and was not expected to receive an organ offer in the near future. Once listed on the HIV-positive organ list, the patient received an organ offer in less than a week.

This patient and the first HIV-positive liver recipient are doing well following their transplants, which were made possible by the Comprehensive Transplant Center’s new HIV-to-HIV transplant program, currently the only-of-its-kind in the Los Angeles area.

“We brought together a team of liver and kidney transplant surgeons, nephrologists, hepatologists, transplant pharmacists, infectious disease experts, transplant coordinators and more to launch this program,” said transplant surgeon Tsuyoshi Todo, MD, who served as the lead surgeon on both the first HIV-to-HIV-positive kidney and HIV-to-HIV-positive liver transplant at Cedars-Sinai.

New HOPE for Transplant Recipients

Cedars-Sinai’s HIV-to-HIV transplant program represents a dramatic shift from just over a decade ago, when federal law prohibited organs from donors with HIV from being transplanted into any patient, including those where were also HIV-positive.

That changed in 2013 with the passage of the HIV Organ Policy Equity (HOPE) Act, which allowed clinical researchers to study HIV-to-HIV transplants. After years of research documented the safety and effectiveness of HIV-to-HIV transplants, the rule was amended in 2024, removing the strict research requirements, and Cedars-Sinai quickly formed a multidisciplinary committee of experts to bring the institution’s HIV-to-HIV program to life.

“Everyone has an important role to play to help patients through this process,” Todo said.

Support for HIV-Positive Patients

Thanks to advances in antiretroviral therapy, people with HIV are living significantly longer and healthier lives, which opens the chance they experience end organ failure due to other comorbidities.

“The vast majority of patients we see living with HIV have their disease well controlled, often with only one pill a day and minimal side effects,” said Christopher Foltz, MD, lead infectious disease specialist for the HIV-to-HIV transplant program at Cedars-Sinai. “In a sense, it’s almost become easier to manage HIV than it is other chronic conditions like hypertension and diabetes.”

Foltz connects with every potential HIV-positive organ recipient as a pre-evaluation to ensure their HIV is managed and, working with Cedars-Sinai pharmacists, determines whether there are any changes that will need to be made to their HIV medication regimen once they are also taking post-transplant immunosuppressant drugs. He also closely follows each patient after their transplant to monitor their HIV viral load and ensure it remains undetectable.

“The first six months post-transplant is when the immune system is being hit the hardest,” Foltz said. “We will monitor the patient’s HIV closely during this time, but eventually, they’ll be able to get back to monitoring once or twice a year, like they would have been doing before.”

Foltz hopes this program encourages more people to register as organ donors as well.

“If you were to ask most people living with HIV, they probably would assume they’re not eligible to be an organ donor, but that is no longer the case,” Foltz said. “Organ donations are lifesaving, and I think it can be really uplifting to them to know they can support others in their community in this way.”

Reduced Wait Times

More than 95,000 patients are on the kidney transplant waitlist, according to data from the Health Resources & Services Administration (HRSA). Most people will wait three to five years for a deceased donor kidney, but that time frame can significantly increase in densely populated areas with a higher demand.

“In Southern California, many patients are actually looking at eight to 10 years on the transplant waitlist, but for HIV-positive patients, being listed on a separate list for HIV-positive donor organs can drastically reduce their wait,” Todo said. “This translates to several years that these patients will not have to be on dialysis, not only getting them back to their normal life more quickly, but also saving hundreds of thousands of taxpayer dollars.”

While patients with kidney failure can live many years on dialysis, there is no similar treatment for patients with liver failure. These patients are listed on the transplant waitlist based on their Model for End-Stage Liver Disease (MELD) score, a number from six to 40 that predicts a patient’s risk of death from liver failure in three months.

“Patients in the Los Angeles area will typically need to have a MELD score in the low 30s in order to receive a transplant, but by accepting an HIV-positive organ that would have otherwise gone to waste, our HIV-positive patient was able to be transplanted with a much lower score,” Todo said. “In the standard circumstance, they would have had to wait significantly longer and get much sicker before receiving an organ.”

Looking Toward the Future

With the first few HIV-to-HIV transplants successfully completed, the team looks forward to making this option available to more HIV-positive patients moving forward.

“At Cedars-Sinai, we strive to be on the leading edge of medical innovation to provide outstanding patient care and support to as many patients as possible, and our HIV-to-HIV transplant program is an example of that effort,” said Irene Kim, MD, director of the Cedars-Sinai Comprehensive Transplant Center. “To be able to transplant more individuals and help them live longer, healthier lives is an honor.”

Read more from Cedars-Sinai Stories and Insights—Being Patient: The Delicate Timing of Organ Transplantation

Within weeks, though, Angelica’s world came crashing down.

“I started getting swelling in my ankles, losing a bunch of weight and just generally not feeling very good,” Ponce said. “I went in for a blood test and knew quickly something was wrong.”

It was a major flare-up of ANCA vasculitis, the autoimmune disease she had been diagnosed with in her teens but had been in remission for several years. Doctors now told her she had more than 60% damage to her kidneys and there was nothing they could do to reverse it. She would need to begin dialysis and, eventually, would require a kidney transplant.  

“It is very unusual for people in their 20s to go into renal failure. Typically, kidney failure is related to diabetes and high blood pressure in patients in their 50s and older,” said Tsuyoshi Todo, MD, a kidney transplant surgeon at Cedars-Sinai. “In Angelica’s case, she was a college athlete and as healthy as they could come. It was very unfortunate she had her kidneys shut down due to her autoimmune disorder.”

Ponce didn’t want to be on dialysis for her wedding, so she put planning on hold and began searching for a kidney donor.

She didn’t have to look very far. Angelica’s younger sister, Miranda Ponce, immediately volunteered to get tested to see if one of her kidneys might be a good match.

When the test results came back, the sisters were a perfect six out of six match.

“That six out of six number indicates the number of matches that Miranda’s body shares in common with Angelica’s body,” said Justin Steggerda, MD, kidney transplant surgeon at Cedars-Sinai who served as the surgeon for Miranda Ponce. “This means Angelica’s body is less likely to react adversely to the transplant and less likely to form some sort of immune response that may later on lead to problems.”

Miranda Ponce said she didn’t hesitate when she found out she was the perfect living donor for her sister.

“I was happy that I had such a good match so that she could have the longest, healthiest years with the best kidney for her,” Miranda Ponce said. “And I knew it would be comforting for us, to go through this whole process together.”

The Ponce sisters went through their kidney transplant surgery at Cedars-Sinai in November 2025. They spent the next few weeks recovering together at their parents’ home in Bellflower, California.

“Anytime a living donor transplant is between siblings or family members, it’s always a really special occasion,” Steggerda said. “In this case, it facilitated Angelica being off dialysis, and I think that’s a really special story.”

Todo said that Angelica’s determination and positive outlook fueled her recovery.

“[Angelica] was determined to not walk down the aisle while she had a dialysis catheter hanging out of her chest,” Todo said. “And the fact that her sister stepped up to help her with a kidney donation for the biggest day of her life is very touching.”

April marks the recognition of Donate Life Month, which promotes awareness about organ donation and honors those who gave the gift of life. To acknowledge this occasion, the Ponce sisters will participate in the annual Donate Life flag raising ceremony at Cedars-Sinai on Wednesday, April 1.

“This month means so much to me, personally. This has become our story now, and being a transplant patient, I feel like I have a voice to raise awareness,” Angelica Ponce said. “By donating a kidney, you give someone their life back, and I feel like my sister gave me my life back because of this.”

With Angelica’s health challenges in the rearview mirror, the Ponce sisters are looking forward to brighter days to come, including Angelica’s wedding in 2027. Miranda will be her sister’s maid of honor.

“This will be my first time being in a wedding so I'm extremely excited,” Miranda Ponce said. “My biggest goal after the transplant was for her to get that wedding and to hopefully one day be a mother and give me nieces and nephews. That’s my biggest dream, honestly, just to be an aunt. So yeah, I'm really excited.”

Read more from Cedars-Sinai Stories and Insights: After Lung Transplant, a Return to Running

Irene Kim, MD, director of the Cedars-Sinai Comprehensive Transplant Center, partially credits the increase in liver transplants to the use of machine perfusion, a technology that circulates oxygen-rich, nutrient-rich, blood-based solution through donor organs until transplantation. Machine perfusion reduces graft dysfunction, allowing organs to be viable longer and improving physicians’ assessments of the organs ahead of transplantation—all of which has served to increase donor organ availability, Kim said.

A willingness to take on the most complex cases also helped drive the increase in lung transplants, according to Kim, as Cedars-Sinai is known for accepting high-risk cases that had been previously turned away by other institutions.

“We are committed to staying on the leading edge of transplant technology to ensure the best results for our patients, with survival outcomes that continue to meet or exceed the national average,” Kim said. “The more organs we can transplant, the more patients can receive a second chance at life. It’s a privilege to not only help these patients, but also to honor the donors who gave the ultimate gift of life.”

According to published data from the Organ Procurement and Transplantation Network (OPTN), 49,065 transplants occurred in the U.S. in 2025—more than in any other year. With records continuing to be set year over year, the OPTN has set an ambitious nationwide goal of 60,000 deceased donor transplants annually by the end of 2026.

New Records in Liver and Lung Transplants, Living Kidney Donors

The Department of Cardiac Surgery in the Smidt Heart Institute is the largest heart transplant center by volume in California, with clinical and surgical teams performing 114 adult heart transplants in 2025. The team, led by Joanna Chikwe, MD, chair of the Department of Cardiac Surgery, Fardad Esmailian, MD, surgical director of the Heart Transplant Program, and Jon Kobashigawa, MD, director of the Heart Transplant Program in the Department of Cardiology, has maintained an average of more than 100 heart transplants each year for the last 13 years, a current record in the U.S.

Surgical Director Dominick Megna, MD, and Medical Director Reinaldo Rampolla, MD, led the lung transplant team to perform 93 lung transplants in 2025—the most ever at Cedars-Sinai—surpassing its previous record of 88 in 2024. The Lung Transplant Program in the Smidt Heart Institute at Cedars-Sinai continues to be the largest by volume in California and, in 2025, earned a place as a top 10 center by volume in the U.S.

The Liver Transplant Program also reached new milestones. The team, led by Kim, as surgical director, and Alexander Kuo, MD, professor of Medicine and medical director of the Liver Transplant Program, performed 145 liver transplants in 2025, exceeding the 2024 record of 136 transplants.

The Kidney Transplant Program team, led by Stanley Jordan, MD, medical director of the Comprehensive Transplant Center’s Human Leukocyte Antigen and Transplant Immunology Laboratory, and Tsuyoshi Todo, MD, surgical director, completed 324 transplants in 2025, including one pancreas-kidney transplant.

Notably, the team performed 80 living donor kidney transplants in 2025, setting a record for the number of living donor kidney transplants performed at Cedars-Sinai, with a more than 15% increase over the previously held record volume of 69 in 2013. This program, led by Steven Wisel, MD, and Reiad Najjar, MD, has transformed into a completely robotic surgical program.

“These achievements are a testament to the hardworking team at the Cedars-Sinai Comprehensive Transplant Center,” said Kim, the Esther and Mark Schulman Chair in Surgery and Transplantation Medicine. “But none of these lifesaving procedures would be possible without the altruism of organ donors and their families. We are tremendously grateful to those who give the gift of life through organ donation.”

Read more from Cedars-Sinai Stories and Insights: After Lung Transplant, a Return to Running

Cedars-Sinai is among the top 10 transplant centers in the U.S. by volume, according to published data from the Organ Procurement and Transplantation Network (OPTN), and is known for accepting complex, high-risk cases.

“Behind every transplant is a patient who desperately waited for a chance at life,” said Irene Kim, MD, director of the Cedars-Sinai Comprehensive Transplant Center. “It is the remarkable generosity of organ donors and their families that allowed our transplant teams to give 682 patients the chance to have longer and healthier lives.”

Cedars-Sinai’s organ transplant program has experienced a 64% year-over-year increase since 2017, when 415 transplants were performed. Over the last decade, its transplant volume has increased by 84%, from 371 in 2014 to 682 in 2024.

Multiple drivers are behind the upward trend in organ transplants at Cedars-Sinai and nationwide, said Kim, the Esther and Mark Schulman Chair in Surgery and Transplantation Medicine.

“Machine perfusion techniques are allowing us to use donor organs that may previously have been less ideal for transplant,” Kim said. “The technology helps preserve organs before transplantation, lengthening viability, improving assessment of organ function and contributing to improved patient outcomes.”

According to the OPTN, 48,149 transplants occurred in the U.S. in 2024—more than in any other year.

But the need for more organs remains significant: More than 100,000 people in the U.S. are on the organ transplant waiting list, according to the United Network for Organ Sharing, the nonprofit organization that manages the U.S. organ transplant system.

Multiple collaborations among various sectors are underway to increase organ donations in an effort to reach a new national goal: 60,000 deceased donor transplants annually in the U.S. by the end of 2026.  

New Records in Heart, Liver and Lung Transplants

The Department of Cardiac Surgery in the Smidt Heart Institute at Cedars-Sinai is home to the largest thoracic organ transplant program by volume in California and the second-largest heart transplant center by volume in the U.S. 

The team, including Joanna Chikwe, MD, chair of the Department of Cardiac Surgery, Fardad Esmailian, MD, surgical director of the Heart Transplant Program, and Jon Kobashigawa, MD, director of the Heart Transplant Program in the Department of Cardiology, led the clinical and surgical teams that performed 137 adult heart transplants, including three heart-lung transplants, surpassing the 2023 record of 132. 

The lung transplant team, led by surgical director Dominick Megna, MD, and medical director Reinaldo Rampolla, MD, also reached a new milestone in 2024 with 88 lungs transplanted (including three heart-lung transplants), up from 82 in 2023. More than a quarter were completed using minimally invasive procedures—2- to 3-inch incisions that lead to reduced pain, recovery times and complications after surgery. Nine percent of minimally invasive lung transplant surgeries at Cedars-Sinai—more than that of any other program in the world—were robotic-assisted.

The liver transplant team, led by Kim, surgical director of the Liver Transplant Program, and Alexander Kuo, MD, professor of Medicine and medical director of the Liver Transplant Program, performed 136 liver transplants in 2024, exceeding the 2021 record of 113 transplants.

The Kidney Transplant Program team, led by Stanley Jordan, MD, medical director of the Comprehensive Transplant Center’s Human Leukocyte Antigen and Transplant Immunology Laboratory, and Tsuyoshi Todo, MD, surgical director, completed 324 transplants in 2024, including five pancreas-kidney transplants. In 2023, the program set a record with 336 kidney transplants performed.

Kim emphasized that the expertise and dedication of Cedars-Sinai’s multidisciplinary transplant teams—physicians, nurses, social workers, pharmacists, physician assistants, dietitians, technicians, perfusionists, researchers, administrative professionals and others—are what enable transplants for so many patients.

“They are the ultimate caregivers,” Kim said. “And it is the organ donors and their families who represent ultimate altruism. They are the foundation that gives others an opportunity at life.”

Read more on the Cedars-Sinai Blog: The Wait for a New Heart