*Purpose: Before passage of the HOPE act in late 2013, HIV infection was an absolute contraindication to organ donation. Retrospective review of the records of a large organ procurement organization (OPO) was undertaken to understand the implementation and outcomes of efforts to redefine HIV as a relative contraindication only for liver + kidney donation.

*Methods: All records for patients referred on ventilators to a single, large OPO from 1/1/15 through 11/14/18 were searched for HIV in the patient’s history or serologic results, the outcome of the triage process (patient excluded vs. on-site evaluation), approach for donation authorization, and donation outcome.

*Results: Over this 4 year period as total referrals to the OPO increased; HIV referrals during this period increased at a faster rate. The intake process evolved such that progressively more HIV referred patients were evaluated on site over time. As time passed, increasingly more HIV patients were also considered medically suitable for donation; approaches for donation authorization increased significantly from 1% of HIV patients in 2015 to 13% in 2018. During this period 4 HIV positive patients became donors of 9 transplanted organs.

*Conclusions: Multidisciplinary efforts to alter the knowledge base of medical suitability for organ donation throughout the donor service area appear to have progressively encouraged the referral of HIV patients. Simultaneously, increasing confidence within the OPO evaluation team appears to have enhanced the opportunities for donation. No indication of saturation of the HIV donation opportunity within this DSA has yet been recognized. Accordingly, continued growth in the HIV potential for donation + transplantation is present.

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