Proof of Concept that Implementation of a Multispecialty Educational Intervention May Improve Acceptance of Organs from Donors with HIV at a Tertiary Care Hospital: A Single-Center Study.

Abstract

Background: People living with HIV have a higher waitlist mortality and decreased access to transplants. The enactment of the HIV Organ Policy Equity Act (HOPE Act) in 2013 was a step toward increasing the donor population. However, utilization of organs through the act has been less than initially anticipated, both nationally and initially at our center.

Methods: To improve the acceptance of abdominal organs from donors with positive HIV tests (D+) for recipients with HIV (R+), we implemented a multidisciplinary educational intervention at our center in December 2020.

Results: Comparing the preintervention period (March 2018-November 2020) to the postintervention period (December 2020-April 2022), the number of organs that were declined for potentially HIV-related reasons decreased significantly from 91% to 63% (p = 0.004). The proportion of organs declined at our center for potentially HIV-related reasons that were accepted later by another center was 40% (10/25) preintervention and 24% (12/49) postintervention (p = 0.2). The rate of transplants/patient-years on our center's waiting list overall tripled (IRR 3.11; 95% CI 1.08-9.44, p = 0.036), with the rate of HIV D+/R+ transplants increasing more dramatically (IRR 16.3; 95% CI 2.90-305, p = 0.009).

Conclusion: Intensive provider education may have an impact on improving rates of transplantation of HIV+ recipients and realizing the potential of the HOPE ACT.