The Challenges and Promise of HIV-Infected Donors for Solid Organ Transplantation

Solid organ transplantation is now the standard of care for many HIV-infected patients with end-stage kidney or liver disease. There is an overall organ shortage that affects all transplant candidates, including those with HIV. The use of HIV-infected donors could help alleviate this shortage. The precedent for this approach was set in South Africa, where promising short-term outcomes have been reported in a limited number of HIV-infected recipients of kidney transplants from HIV-infected donors. As a consequence, the HIV Organ Policy Equity (HOPE) Act was passed in the United States, legalizing research into HIV-infected organ donation. In this review, we discuss some of the key issues related to HIV-infected organ donation, including the need for transplant in HIV-infected populations, characterization of the potential donor pool in the USA, criteria for donor selection, concerns specific to the HIV-infected donor, the ethics of HIV-infected organ donation, and the next steps toward making HIV-infected donation a reality in the USA.