Liang Tao, Salas Jordan H, Bowring Mary G, Kusemiju Oyinkan, Barnaba Brittany, Wingler Matthew, McRann Deborah, Salama Alghidak, Wood R Patrick, Massie Allan, Werbel William, Tobian Aaron A R, Segev Dorry L, Durand Christine M
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Oregon Health & Science University School of Medicine, Portland, OR.
Transplant Direct. 2024 May 16;10(6):e1641. doi: 10.1097/TXD.0000000000001641. eCollection 2024 Jun.
The HIV Organ Policy Equity Act legalizes organ procurement from donors with HIV (HIV D+). A prior survey of Organ Procurement Organizations (OPOs) estimated >2000 HIV D+ referrals/year; however, only 30-35 HIV D+/year have had organs procured. Given this gap, we sought to understand HIV D+ referrals and procurements in practice.
We prospectively collected data on all OPO-reported HIV D+ referrals, including reasons for nonprocurement. We evaluated trends and compared HIV D+ characteristics by procurement status using regression, chi-squared tests, and Wilcoxon rank-sum tests.
From December 23, 2015 to May 31, 2021, there were 710 HIV D+ referrals from 49 OPOs, of which 171 (24%) had organs procured. HIV D+ referrals increased from 7 to 15 per month ( < 0.001), and the procurement rate increased from 10% to 39% ( < 0.001). Compared with HIV D+ without procurement, HIV D+ with procurement were younger (median age 36 versus 50 y), more commonly White (46% versus 36%), and more often had trauma-related deaths (29% versus 8%) (all < 0.001). Nonprocurement was attributed to medical reasons in 63% of cases, of which 36% were AIDS-defining infections and 64% were HIV-unrelated, commonly due to organ failure (36%), high neurologic function (31%), and cancer (14%). Nonprocurement was attributed to nonmedical reasons in 26% of cases, commonly due to no authorization (42%), no waitlist candidates (21%), or no transplant center interest (20%).
In the early years of the HIV Organ Policy Equity Act, actual HIV D+ referrals were much lower than prior estimates; however, the numbers and procurement rates increased over time. Nonprocurement was attributed to both medical and nonmedical issues, and addressing these issues could increase organ availability.
《HIV器官政策公平法案》使从感染HIV的捐赠者（HIV D+）处获取器官合法化。先前对器官获取组织（OPO）的一项调查估计，每年有超过2000例HIV D+转诊；然而，每年只有30 - 35例HIV D+的器官被获取。鉴于这一差距，我们试图了解实际操作中HIV D+的转诊和器官获取情况。
我们前瞻性地收集了所有OPO报告的HIV D+转诊数据，包括未获取器官的原因。我们评估了趋势，并使用回归分析、卡方检验和Wilcoxon秩和检验按获取状态比较了HIV D+的特征。
从2015年12月23日至2021年5月31日，49个OPO有710例HIV D+转诊，其中171例（24%）的器官被获取。HIV D+转诊从每月7例增加到15例（<0.001），获取率从10%增加到39%（<0.001）。与未获取器官的HIV D+相比，获取器官的HIV D+更年轻（中位年龄36岁对50岁），更常见为白人（46%对36%），且更多因创伤相关死亡（29%对8%）（均<0.001）。63%的未获取器官情况归因于医学原因，其中36%是艾滋病界定感染，64%与HIV无关，常见原因是器官衰竭（36%）、高神经功能（31%）和癌症（14%）。26%的未获取器官情况归因于非医学原因，常见原因是未获授权（42%）、没有等待名单候选人（21%）或没有移植中心感兴趣（20%）。
在《HIV器官政策公平法案》实施的早期，实际的HIV D+转诊远低于先前估计；然而，数量和获取率随时间增加。未获取器官归因于医学和非医学问题，解决这些问题可能会增加器官的可获得性。
