Influence of HIV Status on Organ Procurement and Allocation: A Discrete Choice Experiment of Australian Transplant...

People with HIV (PWH) experience disparate access to solid organ transplantation (SOT) but are eligible to be organ recipients and donors in Australia. Clinician decision-making about the allocation and utilization of organs is central to transplant access. This study aimed to determine the influence of HIV infection, and other key attributes, in decision-making about SOT recipients and donors.

We conducted 2 discrete choice experiment (DCE) surveys, using a D-efficient design, among Australian transplant providers. Clinicians were presented with 6 hypothetical SOT recipients and donor pairs and asked to nominate a preferred candidate based on 8 recipient and 6 donor attributes. The DCEs were hosted in Qualtrics and distributed via professional networks. Relative attribute importance was calculated as the percent contribution of each attribute by dividing its utility range by the total of all attribute utility ranges.

Ninety-five respondents completed the recipient, while 87 completed the donor DCE. Most respondents (83.5%) were kidney or liver organ specialists. Expected survival without a transplant was the most influential attribute in the selection (relative importance, 23.1%) of a recipient, while HIV was the least influential factor (0.4%). Conversely, HIV status was the second most important attribute in donor selection (26.6%), behind only organ quality (32.0%).

HIV status had limited influence on the choice of transplant recipients but was the second most influential factor in donor selection. Our results suggest that clinicians' decisions are guided primarily by medical urgency, not HIV status, when choosing a recipient, but that residual concern remains about the use of donors with HIV.