Attitude of HIV patients toward organ transplant between HIV patients: A Cross - Sectional questionnaire survey Dr H Taha [1], Dr Katie Newby [2], Mr A Das [3]Dr S Das [1], [1] Coventry and Warwickshire Partnership Trust [2] University of Coventry, [3] University of Birmingham, School of Medicine-UK A shortage, low number of RTA, also inefficiencies in the donor identification and consent process This guideline recognises the complexities that arise owing to the majority of potential organ donors lacking the capacity to be directly involved in decision making at the time of their death

National organ transplant act Organ transplant and donation activity 2014 march

Background End- stage organ disease, multifactorial. American Federal Law has recently lifted the ban on organ donation from HIV infected individual. Anecdotal report, United Kingdom showed organ transplant between HIV patient could be successful. HIV patients to express their views regarding organ transplant. HIV infection used to be a condition that hinders the use of organs from HIV‐infected deceased individuals South Africa has allowed the transplantation of HIV-infected organs into HIV-infected patients

Aim To study the attitude of HIV patients toward organ transplant, between HIV infected patients.

Subjects and setting Design HIV+ patient attending HIV outpatient clinic from January- July 2013. Design Cross-sectional Questionnaire survey of patients attending the clinic. Full ethical approval. Statistics; Multinomial logistic regression analysis Organ donation for transplantation is a complex area and one to which conventional clinical research methods cannot be easily applied Actual donation rate is poor , many reviews for organ donation done in the past but all failed due to Lack of structured and systematic approach to organ donation

Exclusion Criteria Inclusion criteria Patient with HIV infection 18 and over, informed consent Understanding clear English language Exclusion Criteria Lack of consent Poor English not willing to use interpreter Mental health problems Primary HIV infection

Baseline results 206 participants filled in questionnaire Mean age (+/-SD) 42 (8.8) Female Gender (%) 122 (59) Black Africans (%) 145 (70) Heterosexual (%) 171 (83) Mean CD-4 count (+/-SD) 486 (231) On HAART (%) 185 (90) Mean duration of illness (+/-SD) months 77 (42.7) Mean duration of ARV (+/-SD) months 68 (41) Co- morbidities (%) 84 (41) Alcohol & illicit drug use (%) 9 (4)

Consideration for donating organ 62% Number of patients 16% 22%

Consideration for receiving organ 55% Number of patients 18% 27%

Consideration for donating and receiving organ 48% Number of patients 10% 15%

Consideration to donate and receive organ 48% 62% 55% 48% Number of patients 16% 22% 18% 27% 10% 15% 10% 15%

Multinomial logistic regression model to predict attitude toward organ donation by demographic variables with ‘would consider organ donation’ as the reference group. P=0.01

Multinomial logistic regression model to predict attitude toward receiving organ by demographic variables with ‘would consider receiving organ’ as the reference group. P=0.04 / infect P=0.05 / HAART

Discussion 62% of the participants would consider donating organ to HIV patients HIV patients with organ failure may drive benefit from HIV infected but otherwise high quality organ. Super- infection with different HIV clade. American Journal of Transplantation 2011;11: 1209-1217

Limitations Single centre Small number of participants, Cross sectional questionnaire It does not explain clearly why some people in favour or against donating or receiving organs.

Conclusion The attitude of HIV patients toward organ transplant between HIV patients is encouraging. The use of HIV infected donors could potentially reduce the current waiting list for organs among HIV patients living with end- stage organ disease. Study at a national level may be needed. 16

Acknowledgment All the participants Research team Other health care professionals in Coventry and Warwickshire partnership trust