HIV Update, The OPO’s Perspective

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

HIV infection limits life expectancy

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

Donor = Virus – or Virus + Recipient = Virus + Donor = Virus – or Virus + DONOR VIRUS DISEASE CURRENT STRATEGY Ebstein Barr Mononucleosis, post-transplant 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 Antiviral therapy is curative, consider use in negative recipients Human Immunodeficiency Virus (HIV) AIDS Protocols for HIV positive kidney + liver recipients

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

The 2013 HOPE Act

2018 – 148 HIV referrals 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

2018 – 3 Donors Liver suitable – no interest HIV antibody +, NAT -: Liver, Kidney, Kidney HIV antibody +, NAT +: Kidney, Kidney 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 LiveOnNY 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

Generalization 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