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Am J Transplant. 2018 Oct;18(10):2579-2586. doi: 10.1111/ajt.14993. Epub 2018 Jul 23.

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

Author information

1
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
2
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
3
Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
4
Department of Surgery, University of California, San Francisco, CA, USA.
5
Department of Medicine, University of Alabama, Birmingham, AL, USA.
6
Department of Surgery, Emory University, Atlanta, GA, USA.
7
Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
8
Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
9
Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
10
Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA.
11
National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.

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.

KEYWORDS:

acquired immunodeficiency syndrome (AIDS); clinical research; clinical trial; donors and donation: donor evaluation; infection and infectious agents-viral: human immunodeficiency virus (HIV); infectious disease; law; legislation; organ allocation; organ procurement organization; organ transplantation in general; practice

PMID:
29947471
PMCID:
PMC6160348
[Available on 2019-10-01]
DOI:
10.1111/ajt.14993

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