Estimating the potential pool of HIV-infected deceased organ donors in the United States

Abstract

Human immunodeficiency virus (HIV) is no longer a contraindication to transplantation. For HIV-infected patients, HIV-infected deceased donors (HIVDD) could attenuate the organ shortage and waitlist mortality. However, this practice would violate United States federal law. The goal of this study was to estimate the potential impact of legalizing transplantation of HIV-infected organs by quantifying the potential pool of HIVDD. Using Nationwide Inpatient Sample (NIS) data, HIV-infected deaths compatible with donation were enumerated. Using HIV Research Network (HIVRN) data, CD4 count, plasma HIV-1 RNA level, AIDS-defining illnesses and causes of death were examined in potential HIVDD. Using UNOS data, evaluated donors who later demonstrated unanticipated HIV infections were studied. From NIS, a yearly average of 534 (range: 481-652) potential HIVDD were identified, with 63 (range: 39-90) kidney-only, 221 (range: 182-255) liver-only and 250 (range: 182-342) multiorgan donors. From HIVRN, a yearly average of 494 (range: 441-533) potential HIVDD were identified. Additionally, a yearly average of 20 (range: 11-34) donors with unanticipated HIV infection were identified from UNOS. Deceased HIV-infected patients represent a potential of approximately 500-600 donors per year for HIV-infected transplant candidates. In the current era of HIV management, a legal ban on the use of these organs seems unwarranted and likely harmful.

Figure 1

Eligibility Criteria for Potential Organ Donors identified in NIS 2005–2008.* *Estimates of potential donors are presented as the average number of potential donors 2005–2008 and weighted as per NIS/HCUP. **Ranges are presented with 95% confidence intervals.

Figure 2

Eligibility Criteria for Potential Organ Donors identified in HIVRN 2000–2008.* *Among the 410 patients identified with well-controlled HIV, 234 were from 4 high-volume centers and their causes of death could be examined for compatibility with organ donation.