Impact of expanding HOPE Act experience criteria on program eligibility for transplantation from donors with human immunodeficiency virus to recipients with human immunodeficiency virus

Bowring, Mary G.; Ruck, Jessica M.; Bryski, Mitchell G.; Werbel, William A; Tobian, Aaron A.R.; Massie, Allan B.; Segev, Dorry L.; Durand, Christine M.

doi:10.1016/j.ajt.2023.03.003

Cited by 2 publications

(2 citation statements)

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“…As of November 2022, only 31 transplant centers, roughly 13% of US transplant centers, had an OPTN variance to perform HIV D+/R+ transplants. Low transplant center participation might be due to current required experience thresholds under the HOPE Safeguards, 9 , 17 or it might be due to the additional administrative effort and cost required for a research protocol. These barriers may be lowered if HIV D+/R+ transplantation moves from research to clinical care.…”

Section: Discussionmentioning

confidence: 99%

“…Under current research criteria, only 3% of heart programs and 0% of lung programs are eligible to perform HIV D+/R+ transplants; if these criteria were expanded, 39% of both heart and lung programs could participate. 17 In a study of OPO decisions to pursue HOPE donors, the number of potential organs that could be recovered was the most important attribute. 15 Thus, the possibility of having multiple organs utilized from a donor would likely influence OPOs to evaluate and procure organs from more HIV D+ referrals.…”

Section: Discussionmentioning

confidence: 99%

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

Liang,

Salas,

Bowring

et al. 2024

Transplantation Direct

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Liang,

Salas,

Bowring

et al. 2024

Transplantation Direct

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Overcoming barriers and stigma: new frontiers in solid organ transplantation for people with HIV

Storm,

Durand

2024

Clin Microbiol Rev

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SUMMARY There is a growing need for solid organ transplantation (SOT) for people living with human immunodeficiency virus (HIV). With the advent of antiretroviral therapy, people living with HIV are experiencing increased life expectancies and are, therefore, developing more comorbidities, including end-stage organ disease. In cases of advanced organ failure, SOT is often the best therapeutic option to improve quality of life and overall survival. As organ shortages persist, transplantation of organs from donors with HIV to recipients with HIV has become a potential therapeutic option. This article first reviews the current state of organ transplantation from donors without HIV to recipients with HIV (HIV D−/R+) by organ and discusses key lessons learned from these transplant trials, including those about drug-drug interactions, rejection, and opportunistic infections. It then explores transplantation from donors with HIV to recipients with HIV (HIV D+/R+), a new frontier. Finally, it investigates challenges of implementation, including public awareness and regulatory requirements, and explores future directions for SOT in people living with HIV.

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Impact of expanding HOPE Act experience criteria on program eligibility for transplantation from donors with human immunodeficiency virus to recipients with human immunodeficiency virus

Cited by 2 publications

References 3 publications

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

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

Overcoming barriers and stigma: new frontiers in solid organ transplantation for people with HIV

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