Efficacy of hope: Analysis of organ quality and availability among deceased HIV-positive donors.

Overview

abstract

BACKGROUND: Improved survival among people with HIV (PWH) has led to increased organ failure, necessitating transplantation. In 2013, the HIV Organ Policy Equity (HOPE) Act was passed, allowing PWH to donate organs to other PWH. No study has assessed organ quality and quantity among a national pool of PWH. METHODS: CFAR Network of Integrated Clinical Systems (CNICS), a multicenter study capturing data on PWH, was used to identify 6,504 deaths from 1999-2018. Exclusions included cause of death, chronic kidney disease, fibrosis-4 score≥3.25, and opportunistic infection at time of death. Donor quality was defined by HIV viremia and the Kidney Donor Profile Index (KDPI). The CDC Wonder database, which contains national death data, permitted estimation of deaths among PWH nationally from 1999-2018. Assuming CNICS was representative of PWH nationally, percentages of potential donors were applied to the CDC Wonder cohort. RESULTS: Within CNICS, there were 3,241 (65.9%) potential kidney donors and 3,536 (71.9%) potential liver donors from 1999-2018. Based on viremia and KDPI, 821 were lower-risk kidney donors (16.7%) and 1,206 (24.5%) were lower-risk liver donors. Within CDC Wonder, we identified 12,048 potential donors from 1999-2018. Extrapolating from CNICS to the national cohort suggested 396 kidney donors (792 kidneys) and 433 liver donors annually, with 100 kidney donors (200 kidneys) and 147 livers being lower-risk. CONCLUSION: A substantial number of PWH meet donation criteria, a valuable source of organs for PWH in need of transplants. Our estimates suggest there may be more available organs from PWH than current transplant numbers indicate. This article is protected by copyright. All rights reserved.