Estimated Median Waiting Time for Organ Procurement and Transplantation Network Human Immunodeficiency Virus Organ Policy Equity Act Variance Kidney Candidates: A Propensity Score Matched Analysis

Abstract

Background: Prior to the 2013 HIV Organ Policy Equity (HOPE) Act, which enabled research on the transplantation of solid organs from donors with human immunodeficiency virus (HIV) to candidates living with HIV, it was prohibited for HIV+ individuals to donate organs in the United States. In 2015, alongside the release of HOPE Act research criteria, the Organ Procurement and Transplantation Network (OPTN) made organ allocation policy and system changes to allow HIV+ to HIV+ transplantation.

Methods: The OPTN database was queried for all adult kidney registrations ever waiting from November 23, 2015, to December 31, 2022; the cohort was split into a HOPE cohort (ever willing to accept an HIV+ kidney) and a non-HOPE cohort (all remaining). Estimated median waiting times (eMWTs) were calculated using a period prevalent Kaplan-Meier approach; HOPE registrations were matched 1:5 without replacement to non-HOPE registrations using a logistic regression propensity score.

Results: Using all waiting time, the eMWT for the HOPE cohort was significantly lower than the matched non-HOPE cohort (3.04 years [95% confidence interval {CI}: 2.70, 3.41] versus 5.88 years [95% CI: 5.65, 6.18]). This trend persisted when estimating MWT using other active time and geographical definitions (ignoring geography and donor service area).

Conclusion: These results suggest that transplantation through the OPTN HOPE variance yields decreases eMWT, perhaps reducing the medium and longer-term impacts of living with HIV.

Keywords: Organ Procurement and Transplantation Network (OPTN); access to transplant; clinical research/practice; human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS); organ allocation; organ procurement and allocation.