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Moving from the HIV Organ Policy Equity Act to HIV Organ Policy Equity in action

changing practice and challenging stigma

Doby, Brianna L.a; Tobian, Aaron A.R.b; Segev, Dorry L.c; Durand, Christine M.a

Current Opinion in Organ Transplantation: April 2018 - Volume 23 - Issue 2 - p 271–278
doi: 10.1097/MOT.0000000000000510

Purpose of review The HIV Organ Policy Equity (HOPE) Act, signed in 2013, reversed the federal ban on HIV-to-HIV transplantation. In this review, we examine the progress in HOPE implementation, the current status of HIV-to-HIV transplantation, and remaining challenges.

Recent findings Pursuant to the HOPE Act, the Department of Health and Human Services revised federal regulations to allow HIV-to-HIV transplants under research protocols adherent to criteria published by the National Institutes of Health. The first HIV-to-HIV kidney and liver transplants were performed at Johns Hopkins in March of 2016. Legal and practical challenges remain. Further efforts are needed to educate potential HIV+ donors and to support Organ Procurement Organizations. As of November 2017, there are 22 transplant centers approved to perform HIV-to-HIV transplants in 10 United Network for Organ Sharing regions. To date, 16 Organ Procurement Organizations in 22 states have evaluated HIV+ donors. The National Institutes of Health-funded HOPE in Action: A Multicenter Clinical Trial of HIV-to-HIV Deceased Donor (HIVDD) Kidney Transplantation Kidney Trial will launch at 19 transplant centers in December of 2017. A HOPE in Action Multicenter HIVDD Liver Trial is in development.

Summary Significant progress toward full HOPE implementation has been made though barriers remain. Some challenges are unique to HIV-HIV transplantation, whereas others are amplifications of issues across the current transplant system. In addition to a public health benefit for all transplant candidates in the United States, partnership on the HOPE Act has the potential to address systemic challenges to national donation and transplantation.

aDepartment of Medicine

bDepartment of Pathology

cDepartment of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

Correspondence to Christine M. Durand, MD, Johns Hopkins University School of Medicine, 1830 East Monument Street Room 450D, Baltimore, MD 21205, USA. Tel: +1 410 955 5684; fax: +1 410 614 8518; e-mail:

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