1. Expanding the Donation Opportunity:
From research to transplant through
It All Begins with
Orlando Rodriguez III, Hope ACT Champion

2. Objectives:
Understanding how to identify potential research versus transplantation
Understand how to approach the family for donation for an undisclosed HIV patient
Identifying the protocols needed to make HIV donation successful
How to get staff and hospital onboard with donation

3. What is ?
With more than 100,000 people waiting for an organ transplant in the United States. Every day this number gets bigger, but there are not enough organ donors to help all of these people get the organ transplants they need.
On November 21, 2013 the HOPE Act (HIV Organ Policy Equity Act) was signed into law. This law makes it possible for us to transplant organs from HIV positive people for organ donation. We can also use research to better understand how HIV positive organs can help those in need receive life-saving transplants. By using organs from HIV positive people for organ donation, we can reduce the number of people waiting for transplants, saving lives of both HIV positive and HIV negative people.
To help doctors understand whether or not this will be safe for people with HIV, we need to learn more about potential HIV positive organ donors

4. According to the CDC Florida is ranked 4th in the U
According to the CDC Florida is ranked 4th in the U.S in highest rates of HIV diagnoses
Source: CDC. Diagnoses of HIV infection in the United States and dependent areas, 2015. HIV Surveillance Report 2016;27

5. Life Alliance (LAORA) Service southeast Florida
80+ hospitals in the DSA
Population over 6 million
107 employees

6. LAORA stats for HIV Activity
Implementation began June 1st 2016 the stats are through July 31st 2017
167 HIV referrals, 22 designated as HOPE Act potential
Evaluations for DCD potential did not begin until June 2017
Started with research: First 5 samples
BD only patients with at least one organ transplantable (Liver + Kidney) no thoracic

7. Identifying potential Research vs. Transplant candidates
Research candidates consist of ANY and ALL authorized patients
Things to look for in transplantation:
When was the pt. diagnosed with HIV ?
Has the pt. been compliant with HIV medication ?
CD4 count > 200
Absolute Lymphocyte from CBC w/diff
Above 1,000 good indicator
Hepatitis panel could be ordered- Commonly co-infected with HCV or HBV

8. Transplant candidates testing
Diagnostic testing transplant centers are looking for:
CT scan of abdomen (w/o contrast)
Ultrasound of liver
Liver biopsy (taking into account Coag’s and H&H)
What are they looking for?
If the liver has been severely affected by a disease process.
Identification of liver cirrhosis/fibrosis or development of cirrhosis
Ascites, Surface nodularity, and Splenomegaly

9. Approaching a Hope ACT potential Family
Collaborate with hospital staff
Family awareness
Identifying proper LNOK
Make the request
No change in policy needed!
Remove the question at top that is for a transition phase for me

10. Process for donor family advocates
Educate the family as you would any other family about donation.
Authorization form will be signed and noted for Hope ACT
Research does not require a UNOS#
Authorization will be uploaded into EMR and UNET (if applicable)
HIV transplant follows the same OPTN rules and regulations as any other donor.
UDRAI will be performed for medical history background and patient safety for both research and transplant recipient if applicable.

11. Putting into your Hospitals
Starts off with in-service on the Hope ACT in your hospitals
Change trigger cards to include “ HIV is no longer a rule out”
Donation Champion and Physicians collaboration
Provide case studies and stories of successful transplants
Stats and potential of HIV infected individuals within your service area.
The University of Miami will be hosting a Hope ACT Summit next year!

12. Implemented protocols
*Please see handout*

13. Life Alliance participation in Hope ACT
2 authorizations not recovered
Total of 10 research samples
6th HIV transplant
1st co-infected HIV/Hep-C

14. Case study #1 ANR Problems:
54yo female admitted for cardiac arrest secondary to an overdose
HIV+, Hep C+
Pt was pronounced brain dead
Labs on admission: BUN/CREAT- 14/1.2, T.Bili- 0.4
Labs before approach: BUN/CREAT- 27/0.9, T.Bili- 0.7
Problems:
Poor historian, non-compliant with Antiretroviral treatment
No primary physician or infectious disease doctor
CD-4 count would take 4 days to results
Liver biopsy showed fibrosis and chronic portal inflammation.

15. Case study #2 successful transplant
37yo female admitted for cardiac arrest secondary to overdose
HIV+, Hep C+
Pt was pronounced brain dead
Labs on admission: BUN/CREAT-14/1.19, T.Bili- 0.3
Labs before approach: BUN/CREAT- 66/4.3, T.Bili- 0.2
Process:
Important to mention that we advised the family post transplant in which they were supportive and signing waivers to release pictures to the public.
Diagnosed with HIV in 2015
Hep C panel was ordered due to poor medical history
CD-4 was unable to be performed turn around time was 3-4 days
Abdominal ultrasound performed (unremarkable liver)
Bedside ultrasound guided liver biopsy performed (unremarkable)

16. Things to Remember: This is DONATION treat the referral the same.
Blood samples must be received for research within 48hrs.
There is 24/7 support from Hope in Action.
Reimbursement is done through Hope in Action for all referrals that are evaluated, research samples and donor workup.

17. Training and Information
Our team is willing to come out and educate your staff in order to provide HOPE for the future of HIV transplantation. We are working closely with Hope in Action team to grow this new advancement in science.

18. Resources Brianna Doby Dr. Christine Durand, MD John Hopkins
Website: hopetransplants.org
Facebook: HOPEtransplants

20. It Starts With