Organs from deceased donors with false-positive HIV screening tests: An unexpected benefit of the HOPE act

• Type of Material: Article
• Authors: Christine M. Durand, Johns Hopkins University; Samantha E. Halpern, Johns Hopkins University; Mary G. Bowring, Johns Hopkins University; Gilad A. Bismut, Johns Hopkins University; Oyinkasola T. Kusemiju, Johns Hopkins University; Brianna Doby, Johns Hopkins University; Reinaldo E. Fernandez, Johns Hopkins University; Charles S. Kirby, Johns Hopkins University; Darin Ostrander, Johns Hopkins University; Peter G. Stock, University of California, San Francisco; Shikha G. Mehta, University of Alabama Birmingham; Nicole Turgeon, Emory University; David Wojciechowski, Massachusetts General Hospital; Shirish Huprikar, Icahn School of Medicine; Sander Florman, Icahn School of Medicine; Shane Ottmann, Johns Hopkins University; Niraj M. Desai, Johns Hopkins University; Andrew Cameron, Johns Hopkins University; Allan B. Massie, Johns Hopkins University; Aaron A. R. Tobian, Johns Hopkins University; Andrew D. Redd, Johns Hopkins University; Dorry L. Segev, Johns Hopkins University
• Language: English
• Date: 2018-10-01
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 The American Society of Transplantation and the American Society of Transplant Surgeons
• Final Published Version (URL): http://dx.doi.org/10.1111/ajt.14993
• Title of Journal or Parent Work: American Journal of Transplantation
• ISSN: 1600-6135
• Volume: 18
• Issue: 10
• Start Page: 2579
• End Page: 2586
• Grant/Funding Information: This work was supported by grant numbers K24DK101828 and K01DK101677 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); 1R01AI120938-01A1 and U01AI134591 from the National Institute of Allergy and Infectious Diseases (NIAID); and K23CA177321 from the National Cancer Institute (NCI); and in part by the Division of Intramural Research, NIAID, NIH.
• Keywords: practice; organ procurement organization; law; Science & Technology; acquired immunodeficiency syndrome (AIDS); clinical research; organ allocation; CANDIDATES; Life Sciences & Biomedicine; TRANSMISSION; DONATION; infectious disease; LIVER-TRANSPLANTATION; UNITED-STATES; legislation; organ transplantation in general; INFECTION; donors and donation: donor evaluation; DYNAMICS; RISK; HEPATITIS-C VIRUS; HUMAN-IMMUNODEFICIENCY-VIRUS; Surgery; clinical trial; infection and infectious agentsviral: human immunodeficiency virus (HIV); Transplantation
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Organs from deceased donors with suspected false-positive HIV screening tests were generally discarded due to the chance that the test was truly positive. However, the HIV Organ Policy Equity (HOPE) Act now facilitates use of such organs for transplantation to HIV-infected (HIV+) individuals. In the HOPE in Action trial, donors without a known HIV infection who unexpectedly tested positive for anti-HIV antibody (Ab) or HIV nucleic acid test (NAT) were classified as suspected false-positive donors. Between March 2016 and March 2018, 10 suspected false-positive donors had organs recovered for transplant for 21 HIV + recipients (14 single-kidney, 1 double-kidney, 5 liver, 1 simultaneous liver-kidney). Median donor age was 24 years; cause of death was trauma (n = 5), stroke (n = 4), and anoxia (n = 1); three donors were labeled Public Health Service increased infectious risk. Median kidney donor profile index was 30.5 (IQR 22-58). Eight donors were HIV Ab+/NAT-; two were HIV Ab-/NAT+. All 10 suspected false-positive donors were confirmed to be HIV-noninfected. Given the false-positive rates of approved assays used to screen > 20 000 deceased donors annually, we estimate 50-100 HIV false-positive donors per year. Organ transplantation from suspected HIV false-positive donors is an unexpected benefit of the HOPE Act that provides another novel organ source.