Deceased Donors With HIV in the Era of the HOPE Act: Referrals and Procurement

Area of Science:

• Transplantation immunology
• Public health policy
• Organ procurement and logistics

Background:

• The HIV Organ Policy Equity Act (HOPE Act) permits organ procurement from deceased individuals with HIV (HIV D+).
• Previous estimates suggested over 2000 HIV D+ referrals annually, yet only 30-35 HIV D+ organs were procured yearly.
• A significant disparity exists between estimated referrals and actual organ procurements from HIV D+ donors.

Purpose of the Study:

• To investigate the practical implementation of organ procurement from HIV D+ donors under the HOPE Act.
• To identify and analyze the reasons for nonprocurement of organs from eligible HIV D+ referrals.
• To understand trends in HIV D+ referrals and procurement rates over time.

Main Methods:

• Prospective data collection on all HIV D+ referrals reported by Organ Procurement Organizations (OPOs).
• Analysis of reasons for organ nonprocurement.
• Statistical evaluation of trends using regression, chi-squared, and Wilcoxon rank-sum tests.
• Comparison of characteristics between procured and non-procured HIV D+ donors.

Main Results:

• Between December 2015 and May 2021, 710 HIV D+ referrals occurred, with 171 (24%) resulting in organ procurement.
• HIV D+ referrals and procurement rates significantly increased over the study period (P < 0.001).
• Procured donors were younger, more often White, and more frequently died from trauma compared to non-procured donors (P < 0.001).
• Medical reasons (organ failure, high neurologic function, cancer) accounted for 63% of nonprocurements, while nonmedical reasons (no authorization, no waitlist candidates) accounted for 26%.

Conclusions:

• Actual HIV D+ referrals were lower than initially estimated, but referral and procurement rates grew post-HOPE Act implementation.
• Both medical and nonmedical factors contribute to organ nonprocurement from HIV D+ donors.
• Addressing identified barriers is crucial to enhance organ availability from the HIV D+ donor pool.