HIV Update The OPOs Perspective Recipient HIV HIV

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HIV Update, The OPO’s Perspective

HIV Update, The OPO’s Perspective

Recipient = HIV + HIV infection limits life expectancy True until 1995

Recipient = HIV + HIV infection limits life expectancy True until 1995

HIV infection limits life expectancy

HIV infection limits life expectancy

Recipient = HIV + Donor = HIV - HIV infection + transplantation is too

Recipient = HIV + Donor = HIV - HIV infection + transplantation is too dangerous

Recipient = Virus + Donor = Virus – or Virus + DONOR VIRUS DISEASE

Recipient = Virus + Donor = Virus – or Virus + DONOR VIRUS DISEASE CURRENT STRATEGY Ebstein Barr Mononucleosis, posttransplant lymphoma Antiviral therapy for EBV negative recipients Cytomegalovirus Pneumonitis, hepatitis Antiviral therapy for CMV negative recipients Hepatitis B Hepatitis, hepatocellular carcinoma Immunize transplant candidates, antiviral therapy for negative recipients Hepatitis C Hepatitis, hepatocellular carcinoma Antiviral therapy is curative, consider use in negative recipients Human Immunodeficiency Virus (HIV) AIDS Protocols for HIV positive kidney + liver recipients

Donor = HIV + HIV infection + organ donation is illegal True until 11/21/2013

Donor = HIV + HIV infection + organ donation is illegal True until 11/21/2013

The 2013 HOPE Act

The 2013 HOPE Act

 • • • Hepatitis B co-infection – 8 Hepatitis C co-infection – 18

• • • Hepatitis B co-infection – 8 Hepatitis C co-infection – 18 Cancer – 19 • Lymphoma – 7 • Prostate – 2 • Laryngeal – 2 • Lung – 2 • Leukemia – 1 • Breast – 1 • Kaposi – 1 • Ovarian – 1 • Germ Cell – 1 • Other - 1 2018 – 148 HIV referrals

1. HIV antibody +, NAT -: Liver, Kidney 2. HIV antibody +, NAT +:

1. HIV antibody +, NAT -: Liver, Kidney 2. HIV antibody +, NAT +: Kidney, Kidney 3. HIV antibody +, Nat -: Kidneys discarded (25% glomerulosclerosis) Liver suitable – no interest 2018 – 3 Donors

HIV Organ Donation • Education for all stakeholders is ongoing • Potential in Live.

HIV Organ Donation • Education for all stakeholders is ongoing • Potential in Live. On. NY donor service area still unknown • More work for evaluation and donation fulfillment than general donation • False positive HIV donation significant • Expansion of organ donor pool

 • Referral of all patients meeting triggers • Allow OPO to make selection

• Referral of all patients meeting triggers • Allow OPO to make selection • OPO has broad access to expert resources (e. g. , Transplant Infectious Disease Experts) Generalization