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. 2024 May 16;10(6):e1641.
doi: 10.1097/TXD.0000000000001641. eCollection 2024 Jun.

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

Tao Liang  1 , Jordan H Salas  1   2 , Mary G Bowring  1 , Oyinkan Kusemiju  1 , Brittany Barnaba  1 , Matthew Wingler  3 , Deborah McRann  4 , Alghidak Salama  5 , R Patrick Wood  6 , Allan Massie  7 , William Werbel  1 , Aaron A R Tobian  8 , Dorry L Segev  7 , Christine M Durand  1
Affiliations

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

Tao Liang et al. Transplant Direct. .

Abstract

Background: The HIV Organ Policy Equity Act legalizes organ procurement from donors with HIV (HIV D+). A prior survey of Organ Procurement Organizations (OPOs) estimated >2000 HIV D+ referrals/year; however, only 30-35 HIV D+/year have had organs procured. Given this gap, we sought to understand HIV D+ referrals and procurements in practice.

Methods: We prospectively collected data on all OPO-reported HIV D+ referrals, including reasons for nonprocurement. We evaluated trends and compared HIV D+ characteristics by procurement status using regression, chi-squared tests, and Wilcoxon rank-sum tests.

Results: From December 23, 2015 to May 31, 2021, there were 710 HIV D+ referrals from 49 OPOs, of which 171 (24%) had organs procured. HIV D+ referrals increased from 7 to 15 per month (P < 0.001), and the procurement rate increased from 10% to 39% (P < 0.001). Compared with HIV D+ without procurement, HIV D+ with procurement were younger (median age 36 versus 50 y), more commonly White (46% versus 36%), and more often had trauma-related deaths (29% versus 8%) (all P < 0.001). Nonprocurement was attributed to medical reasons in 63% of cases, of which 36% were AIDS-defining infections and 64% were HIV-unrelated, commonly due to organ failure (36%), high neurologic function (31%), and cancer (14%). Nonprocurement was attributed to nonmedical reasons in 26% of cases, commonly due to no authorization (42%), no waitlist candidates (21%), or no transplant center interest (20%).

Conclusions: In the early years of the HIV Organ Policy Equity Act, actual HIV D+ referrals were much lower than prior estimates; however, the numbers and procurement rates increased over time. Nonprocurement was attributed to both medical and nonmedical issues, and addressing these issues could increase organ availability.

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Conflict of interest statement

W.A.W. received consulting fees from AstraZeneca, the Centers for Disease Control and Prevention/Infectious Diseases Society of America COVID-19 Real-Time Learning Network, GlobalData, and advisory board fees from AstraZeneca and Novavax. D.L.S. receives consulting fees from AstraZeneca, Novavax, CareDx, Moderna Therapeutics, Regeneron, and Springer Publishing as well as speaking honoraria from AstraZeneca, CareDx, Optum Health Education, Sanofi, and WebMD. C.M.D. receives honoraria from Gilead Sciences for serving on a grant review committee and Gilead provides drug for several investigator-initiated clinical trials of C.M.D. The other authors declare no conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Referral outcomes of deceased HIV D+. HIV D+, donors with HIV; OPOs, Organ Procurement Organizations.
FIGURE 2.
FIGURE 2.
Trend over time in HOPE Act participation and HOPE donor procurement. Trends over time in (A) OPOs reporting HIV D+ referrals and transplant centers with consented candidates for HOPE trials. The cumulative number of OPOs that began reporting HIV D+ referrals is based on the first date of HIV D+ referral from that OPO. The cumulative number of transplant centers consenting candidates for HOPE is based on the first date a candidate was consented for HOPE at that center. B, HIV D+ referrals, procurements, and procurement percent. Each line represents the fitted univariable linear regression line of the displayed value over calendar months. HIV D+, donors with HIV; HOPE, HIV Organ Policy Equity; OPOs, Organ Procurement Organizations.
FIGURE 3.
FIGURE 3.
HOPE donor referrals and procurements by OPO. A, Overall procurement percent vs total HIV D+ referrals for each OPO and (B) total HIV D+ referrals for each OPO by OPTN region. Each point represents 1 OPO. Transparency and random jitter applied to illustrate overlap between OPOs. HIV D+, donors with HIV; OPO, Organ Procurement Organization; OPTN, Organ Procurement Transplantation Network.
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References

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