1. HIV Update, The OPO’s Perspective

2. HIV infection limits life expectancy
Recipient = HIV +
HIV infection limits life expectancy
True until 1995

3. HIV infection limits life expectancy

4. HIV infection + transplantation is too dangerous
Recipient = HIV +
Donor = HIV -
HIV infection + transplantation is too dangerous

5. Donor = Virus – or Virus +
Recipient = Virus +
Donor = Virus – or Virus +
DONOR VIRUS
DISEASE
CURRENT STRATEGY
Ebstein Barr
Mononucleosis, post-transplant lymphoma
Antiviral therapy for EBV negative recipients
Cytomegalovirus
Pneumonitis, hepatitis
Antiviral therapy for CMV negative recipients
Hepatitis B
Hepatitis, hepatocellular carcinoma
Immunize transplant candidates, antiviral therapy for negative recipients
Hepatitis C
Antiviral therapy is curative, consider use in negative recipients
Human Immunodeficiency Virus (HIV)
AIDS
Protocols for HIV positive kidney + liver recipients

6. HIV infection + organ donation is illegal
Donor = HIV +
HIV infection + organ donation is illegal
True until 11/21/2013

7. The 2013 HOPE Act

12. 2018 – 148 HIV referrals Hepatitis B co-infection – 8
Hepatitis C co-infection – 18
Cancer – 19
Lymphoma – 7
Prostate – 2
Laryngeal – 2
Lung – 2
Leukemia – 1
Breast – 1
Kaposi – 1
Ovarian – 1
Germ Cell – 1
Other - 1
2018 – 148 HIV referrals

13. 2018 – 3 Donors Liver suitable – no interest
HIV antibody +, NAT -: Liver, Kidney, Kidney
HIV antibody +, NAT +: Kidney, Kidney
HIV antibody +, Nat -: Kidneys discarded (25% glomerulosclerosis)
Liver suitable – no interest
2018 – 3 Donors

14. HIV Organ Donation Education for all stakeholders is ongoing
Potential in LiveOnNY donor service area still unknown
More work for evaluation and donation fulfillment than general donation
False positive HIV donation significant
Expansion of organ donor pool

16. Generalization Referral of all patients meeting triggers
Allow OPO to make selection
OPO has broad access to expert resources (e.g., Transplant Infectious Disease Experts)
Generalization