Background

Since the HIV Policy Equity Act of 2013, 22 programs have been approved to use HIV+ kidneys and livers, yet these transplants remain uncommon. It is unknown whether this derives from a small pool of suitable donors or from transplant community concerns about organ utility and provider safety.

Methods

We designed an online survey of the national abdominal and cardiothoracic transplant community to elucidate attitudes towards the use of HIV+ donors. Email surveys were administered to 1071 ASTS Regular Members, 187 Candidate Members (trainees) and 602 cardiothoracic surgeons registered with UNOS. Survey questions included Likert scales with 10 representing “Highly superior,” “Definitely yes,” etc. and 0 representing the opposite. Results are reported as medians with interquartile ranges (IQR).

Results

348 (18.7%) of those surveyed responded. 19 described themselves as not transplant surgeons; 7 of these indicated they participate in organ procurement. Of the 329 transplant surgeons, 217 (66.0%) had transplanted an HIV+ recipient. Only 39 of the 311 procurement surgeons (12.5%) had procured organs from an HIV+ donor. Most felt that HIV+ organs would have slightly worse outcomes than those from HIV- donors (median 4.9, IQR 4, 5). Around half (49.4%) reported that their center planned to use HIV+ donors, but most felt that this would decrease the organ shortage only “a little” (median 2.6, IQR 1.9, 3.5). 92% reported a needle stick or other infectious exposure; 108 (31.0%) had taken prophylaxis. When asked to estimate risk of HIV infection for both brain dead (DBD) and donation after cardiac death (DCD) procurements, the plurality chose “between 1 in a million and 1 in 100,000” (38.8%, 35.1% respectively). Procurement surgeons described themselves as comfortable with HIV+ DBD (median 8, IQR 5, 10) but less so with DCD (median 6, IQR 3, 9).

Conclusions

Surgeons are optimistic about the quality of HIV+ organs but do not feel that the use of these donors will alleviate the organ shortage. Surgeons have almost universally suffered a needle stick or other exposure yet judge the risk of contracting HIV low and feel comfortable procuring HIV+ organs, particularly DBD. Thus, transplant community outlook does not appear to explain the limited number of HIV+ organs used to date.

CITATION INFORMATION: Nazarian S., Watts C., Sawinski D., Reese P., Goldberg D., Abt P., Halpern S., Shea J., Blumberg E. Why the Low Usage of HIV Positive Donors? A Survey of the Transplant Community Am J Transplant. 2017;17 (suppl 3).

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