Background. HIV is no longer a contraindication to solid organ 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 (NOTA). We describe a 2-year long effort to legalize the transplantation of HIV-infected organs.

Methods. In order to introduce federal legislation, the following methods were employed: generation of research data describing the potential pool of donors (i.e. the potential increase in number of transplants resulting from this change to NOTA), meetings with key legislative health staffers on Capitol Hill, organization of a congressional briefing with an expert panel, media exposure, and building a coalition with national transplant, HIV, and medical organizations.

Results. After having estimated the potential pool of HIV-infected donors to be 500-600/year (AJT 2011), 5 high profile international news articles were published (including New York Times). Subsequently, a coalition of 25 national HIV/AIDS and transplant societies was formed. Bipartisan sponsorship was achieved in the House and Senate after 70 meetings on Capitol Hill. A congressional briefing was held to educate more than 100 Capitol Hill staffers about the repeal. Legislation is being drafted and a bill will be introduced in the 113th Congress.

Conclusion. Given initial success with transplantation of HIV-infected organs in South Africa, a legal ban on the use of these organs in the United States, in the current era of HIV knowledge and management, seems unwarranted and likely harmful. This study demonstrates the steps for effective federal advocacy for evidence-based transplant practice.

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