Knowledge, attitudes, and planned practice of HIV ‐positive to HIV ‐positive transplantation in US transplant centers

Background HIV + donor organs can now be transplanted into HIV + recipients ( HIV D+/R+) following the HIV Organ Policy Equity ( HOPE ) Act. Implementation of the HOPE Act requires transplant center awareness and support of HIV D+/R+ transplants. Methods To assess center‐level barriers to implementation, we surveyed 209 transplant centers on knowledge, attitudes, and planned HIV D+/R+ protocols. Results Responding centers (n = 114; 56%) represented all UNOS regions. Fifty centers (93 organ programs) planned HIV D+/R+ protocols (kidney n = 48, liver n = 34, pancreas n = 8, heart n = 2, lung = 1), primarily in the eastern United States (28/50). Most (91.2%) were aware that HIV D+/R+ transplantation is legal; 21.4% were unaware of research restrictions. Respondents generally agreed with HOPE research criteria except the required experience with ≥5 HIV + transplants by organ type. Centers planning HIV D+/R+ protocols had higher transplant volume, HIV + recipient volume, increased infectious risk donor utilization, and local HIV prevalence ( P  < 0.01). Centers not planning HIV D+/R+ protocols were more likely to believe their HIV + candidates would not accept HIV + donor organs ( P  < 0.001). Most centers (83.2%) supported HIV + living donation. Conclusions Although many programs plan HIV D+/R+ transplantation, center‐level barriers remain including geographic clustering of kidney/liver programs and concerns about HIV + candidate willingness to accept HIV + donor organs.