Federal Government Approves Kidney, Liver Transplants Between Individuals With HIV

A person holds an HIV testing kit in Charleston, W.Va., on March 9, 2021. John Raby/AP Photo

The federal government has lifted a ban that prevented kidney and liver transplants between HIV-positive individuals, in an attempt to offer them a higher chance of accessing these procedures.

Before 2013, transplantation of organs from people with HIV was prohibited in the United States. The HIV Organ Policy Equity (HOPE) Act, signed into law in 2013 and effective from 2015, removed this prohibition, allowing organ transplantation from HIV-positive individuals to other HIV-positive people. However, such procedures were only allowed as part of research studies.

On Nov. 26, the U.S. Department of Health and Human Services (HHS) announced a final rule that removes the clinical research requirement, meaning HIV-positive people will now be able to receive kidney and liver donations from other HIV-positive individuals without being part of a research study.

Previously, transplants required approval from an institutional review board. This requirement has also been abolished under the final rule.

This new regulation “removes unnecessary barriers to kidney and liver transplants, expanding the organ donor pool and improving outcomes for transplant recipients with HIV,” HHS Secretary Xavier Becerra said in a statement. “We continue to do everything in our power to increase access to life-saving organs while addressing health inequities faced by people with HIV.”

HHS said that the latest decision was taken after considering a “large body of evidence,” including recent findings from a National Institutes of Health (NIH) study showing that kidney transplants between HIV donors and HIV recipients were not worse than or inferior to transplants between non-HIV donors and HIV recipients.

The new rule came into effect on Nov. 27.

The NIH is also seeking public comments on the possibility of removing research study requirements under the HOPE Act for transplanting other organs such as lungs, pancreas, and the heart.

People with HIV are living longer, resulting in higher cases of end-stage diseases affecting organs such as the kidney, heart, and liver, according to the HHS website HIV.org. As a result, there is a high demand for transplanting these organs but donor organs are in short supply.

The new rule attempts to alleviate the shortage issue. Since the implementation of the HOPE Act, more than 440 organs are estimated to have been transplanted from HIV donors to HIV recipients.

Transplant Safety, HIV Prevalence

A recent study by researchers from NYU Langone Health showed that kidney transplants between people with HIV infections were “safe and effective,” according to an Oct. 17 statement.

Researchers found that survival rates among transplant recipients were the same whether they received organs from an HIV donor or a non-HIV one. The survival rates were checked one and three years after the surgery. The risk of side effects, such as infections or rejected organs, was found to be the same.

“These findings offer hope for the thousands of people with HIV in the United States and around the world who are in need of kidney transplantation, and to many more people where HIV infection and kidney diseases are more common,” senior study investigator and transplant surgeon Dorry L. Segev said.

A microscopic view of the human immunodeficiency virus (HIV) on a lymphocyte, in an undated file photo. AFP/Getty Images

NYU Langone Health said that almost 90,000 Americans are awaiting kidney transplants, and those with HIV are more than twice as likely to die while waiting for the procedure.

HIV numbers have dipped globally, according to a recent report by the Joint U.N. Programme on HIV/AIDS (UNAIDS).

Last year, 630,000 people died from AIDS-related causes worldwide, the report noted. This is down by 69 percent from 2004, when deaths hit a peak of 2.1 million.

“Fewer people acquired HIV in 2023 than at any point since the late 1980s. Almost 31 million people were receiving lifesaving antiretroviral therapy in 2023, a public health success that has reduced the numbers of AIDS-related deaths to their lowest level since the peak in 2004,” the report states.

In the United States, more than 38,000 people had an HIV diagnosis in 2022, according to data from the U.S. Centers for Disease Control and Prevention. Nearly 80 percent were men, with gay and bisexual men making up the majority of cases.