CD4 Count in HIV− Brain-Dead Donors

Abstract

Absolute numbers of CD4 and CD8 T-lymphocytes are commonly reduced after brain death in HIV- individuals. Thus, CD4 absolute numbers are an inconsistent metric for assessing organ donor risk, irrespective of HIV status.

HIV+ deceased donor referrals: A national survey of organ procurement organizations

“…19 In addition, a recent study of 20 conventional brain death donors found that 55% of these HIVuninfected donors had a CD4 <200. 23 This indicates that in the setting of brain death, the CD4 count may not be a reliable metric for infectious risk. In the study by Richterman et However, this study represents the largest report of HIV D+ referrals to date in the USA.…”

“…Prior to HOPE Act implementation, candidates' HIV status was not collected at the time of wait‐listing. To estimate the potential pool of HIV+ transplant candidates, a recent study used pharmacy claims and data from the Scientific Registry of Transplant Recipients to identify 727 HIV+ kidney transplant candidates between 2009 and 2012 . This was only a subset of HIV+ individuals who could benefit from transplantation, underscoring the substantial need for organs and the potential public health impact of HIV D+ organs for HIV+ individuals with end‐stage kidney disease.…”

“…However, the HOPE Safeguards and Research Criteria allow consideration of any HIV D+, regardless of the CD4 or viral load, provided there are no active opportunistic infections and a safe antiretroviral regimen is anticipated for the recipient . In addition, a recent study of 20 conventional brain death donors found that 55% of these HIV‐uninfected donors had a CD4 <200 . This indicates that in the setting of brain death, the CD4 count may not be a reliable metric for infectious risk.…”

National Landscape of Human Immunodeficiency Virus–Positive Deceased Organ Donors in the United States

“…Donor characteristics are shown in Table 1. Comparing HIVpositive and FP donors, the median age (IQR) was 36 (29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46) versus 31 (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41) years, respectively (P = .01); 76% versus 65% were male (P = .25); and 37% versus 44% were white (P = .21). The median body mass index (IQR) (calculated as weight in kilograms divided by height in meters squared) was 25.2 (22.7-29) in HIV-positive and 28.4 (22.1-34.8) in FP donors (P = .11).…”

Moving from the HIV Organ Policy Equity Act to HIV Organ Policy Equity in action

“…This guideline is supported by the fact that there were no CD4 exclusions applied to HIV+ donors in South Africa [10]. In addition, a recent study demonstrated that in the setting of brain death a donor’s CD4 count may not be a reliable metric of infectious risk to the recipient [41]. The federal criteria are fairly minimal: 1) donors cannot have evidence of an active opportunistic infection, 2) any CD4 count or HIV plasma RNA level is allowed, as long as a study team can describe an effective post-transplant antiretroviral regimen in the recipient.…”