For nearly thirty years, no transplantable organs could be recovered in the United States from anyone known to be HIV-positive. While this prohibition began at a time when detection and clinical treatment of the virus were largely ineffective, it continued into an era when both detection and management have made great advances. In that time, many people who have had a long-term history of well-managed HIV treatment have encountered a more immediate health threat from end-stage organ failure.
The HIV Organ Policy Equity Act (also known as the HOPE Act), signed into law Nov. 21, 2013, called for the use of organs from HIV-positive donors for transplantation into HIV-positive candidates under approved research protocols designed to evaluate the feasibility, effectiveness and safety of such organ transplants. The provisions of the Act were made effective two years later, on Nov. 21, 2015.
“Early indications show the HOPE Act will not only provide extended opportunities for HIV-positive candidates to receive organs, but it also offers people with HIV the potential to donate organs for the first time,” said Cameron Wolfe, M.D., chair of the OPTN/UNOS Ad Hoc Disease Transmission Advisory Committee. “For a group of individuals all too familiar with medically and socially inconsistent stigma, this can indeed offer real hope.”
As of November 18, 2016, 19 transplants (13 kidney and six liver transplants) have been performed involving organs from HIV-positive donors for HIV-positive recipients. Thirteen transplant hospitals have enrolled with the OPTN to participate in research studies, and approximately 80 candidates are currently listed to receive organ offers from HIV-positive donors.
Any participating hospital must conduct transplants under IRB-approved research protocols conforming to the Final Human Immunodeficiency Virus (HIV) Organ Policy Equity (HOPE) Act Safeguards and Research Criteria for Transplantation of Organs Infected with HIV, which were developed by the National Institute of Allergy and Infectious Diseases, one of the National Institutes of Health.
Organ procurement organizations are able to run matches for HIV-positive donors. The only candidates who will appear on match runs for these donor offers will be those listed at transplant programs that have an IRB-approved protocol, and whose HIV status and willingness to accept an HIV positive kidney or liver has been confirmed.
“The transplant community will be closely watching the outcomes of these transplants in a couple different ways,” said Dr. Wolfe. “First, we want to ensure the safety of patients involved. Secondly, we want to compare length of organ function and patient survival for recipients of HIV-positive organs to see if they are similar to those of HIV-negative organs. This information will help assess the feasibility of using HIV-positive donor organs, and will help clinicians advise patients to make decisions that will benefit their long-term care.”More information about the HOPE Act and related OPTN policy is available here.