The HIV Organ Policy Equity Act mandates research on the use of HIV-infected (HIV+) deceased donors (HIVDD) for transplantation in HIV+ recipients. The only data on the potential size of the HIVDD is limited to conservative estimates from national death registry data, which estimates about 500-600 per year. Organ Procurement Organizations (OPOs) receive referrals for all potential deceased donors, including HIVDD, and could provide more accurate estimates.

Methods: We distributed surveys to all 58 OPOs. We asked whether OPOs track referrals a) known to be HIV+ and/or b) cases discovered to be HIV+ upon donor evaluation. If OPOs did not track referrals, estimates were provided. Finally, we asked whether OPOs support research in HIV-to-HIV organ transplantation.

Results: 55 % (32/58) of surveys have been completed. Of these, 34% (11/32) of OPOs track annual HIVDD referrals. These OPOs reported a total of 543 potential HIVDD in 2013, with a median of 52.5 per OPO. 66% of OPOs (22/32) provided approximations, with an additional 496 estimated potential HIVDD, median 42 per OPO. The vast majority (91%) of OPOs indicated that their estimate accurately reflects potential HIVDD in their area; those that did not felt their estimates likely underestimated the HIVDD pool. 97% of OPOs support research related to HIV-to-HIV transplantation.

We performed a linear regression analysis to predict the total number of HIVDD in each OPO region using AIDS prevalence by region (correlation coefficient = 0.58). 2,425 total HIV+ referrals were projected in the United States per year.

Discussion: Based on OPO estimates, there are nearly 2500 potential HIVDD per year in the US. This estimate supersedes prior approximations based on national death registry data, which indicated 500-600 potential HIVDD. Use of these donors has the potential to attenuate the organ shortage crisis and decrease waitlist mortality for HIV+ and HIV-uninfected individuals alike.

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