Potential donor characteristics and decisions made by organ procurement organization staff: Results of a discrete choice experiment

Predmore, Zachary; Doby, Brianna; Durand, Christine M.; Segev, Dorry L.; Sugarman, Jeremy; Tobian, Aaron A.R.; Wu, Albert W.

doi:10.1111/tid.13721

Cited by 6 publications

(4 citation statements)

References 33 publications

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“…Perceived barriers and disincentives to pursue HIV D+ at the OPO level have been identified in prior studies. 15 , 16 A study by Predmore et al, 16 which included in-depth interviews with 20 OPO staff members, identified OPO concerns regarding HIV disclosure to next-of-kin and fear of HIV infection to procurement staff. In practice, these concerns should not be barriers to donation and procurement.…”

Section: Discussionmentioning

confidence: 99%

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Deceased Donors With HIV in the Era of the HOPE Act: Referrals and Procurement

Liang,

Salas,

Bowring

et al. 2024

Transplantation Direct

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Background. The HIV Organ Policy Equity Act legalizes organ procurement from donors with HIV (HIV D+). A prior survey of Organ Procurement Organizations (OPOs) estimated >2000 HIV D+ referrals/year; however, only 30–35 HIV D+/year have had organs procured. Given this gap, we sought to understand HIV D+ referrals and procurements in practice. Methods. We prospectively collected data on all OPO-reported HIV D+ referrals, including reasons for nonprocurement. We evaluated trends and compared HIV D+ characteristics by procurement status using regression, chi-squared tests, and Wilcoxon rank-sum tests. Results. From December 23, 2015 to May 31, 2021, there were 710 HIV D+ referrals from 49 OPOs, of which 171 (24%) had organs procured. HIV D+ referrals increased from 7 to 15 per month (P < 0.001), and the procurement rate increased from 10% to 39% (P < 0.001). Compared with HIV D+ without procurement, HIV D+ with procurement were younger (median age 36 versus 50 y), more commonly White (46% versus 36%), and more often had trauma-related deaths (29% versus 8%) (all P < 0.001). Nonprocurement was attributed to medical reasons in 63% of cases, of which 36% were AIDS-defining infections and 64% were HIV-unrelated, commonly due to organ failure (36%), high neurologic function (31%), and cancer (14%). Nonprocurement was attributed to nonmedical reasons in 26% of cases, commonly due to no authorization (42%), no waitlist candidates (21%), or no transplant center interest (20%). Conclusions. In the early years of the HIV Organ Policy Equity Act, actual HIV D+ referrals were much lower than prior estimates; however, the numbers and procurement rates increased over time. Nonprocurement was attributed to both medical and nonmedical issues, and addressing these issues could increase organ availability.

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Section: Discussionmentioning

confidence: 99%

“… 17 In a study of OPO decisions to pursue HOPE donors, the number of potential organs that could be recovered was the most important attribute. 15 Thus, the possibility of having multiple organs utilized from a donor would likely influence OPOs to evaluate and procure organs from more HIV D+ referrals.…”

Section: Discussionmentioning

confidence: 99%

Deceased Donors With HIV in the Era of the HOPE Act: Referrals and Procurement

Liang,

Salas,

Bowring

et al. 2024

Transplantation Direct

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“…Stigma both within and outside of the healthcare system continues to be a barrier, impacting potential HOPE donors, recipients, and transplant centres [51 ▪ ]. More specifically, there seems to be preference for donors without HIV over donors with HIV in Organ Procurement Organizations (OPOs) which may be due to the small pool of candidates with HIV that can accept these organs, potential concerns about acquisition costs given that only kidney and livers are being transplanted currently, and HIV stigma within the healthcare system [51 ▪ ]. Education about HIV organ donation, interventions to reduce HIV stigma, and partnerships with HIV organizations might help further break down the barriers that prevent the HOPE Act from reaching its full potential [50].…”

Section: Opportunities To Expand Human Immunodeficiency Virus D+/r+ S...mentioning

confidence: 99%

Donors with human immunodeficiency virus and hepatitis C virus for solid organ transplantation: what's new

Lushniak

Durand

2022

Current Opinion in Infectious Diseases

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Purpose of the reviewPassage of the HOPE Act and the advent of direct-acting antiviral (DAA) therapies have allowed for expansion of the donor organ pool to include donors with human immunodeficiency virus (HIV) and hepatitis C virus (HCV), thus providing new opportunities for waitlist candidates. This article provides updates on recent studies in solid organ transplantation (SOT) utilizing donors with HIV and HCV.Recent findingsThe first pilot studies of kidney and liver transplantation from donors-with-HIV to recipients-with-HIV (HIV D+/R+) show robust patient survival, comparable graft survival to transplantation from donors without HIV (HIV D-/R+) and no increased rates of HIV breakthrough. The number of HIV D+ organs utilized has been lower than initial estimates due to several potential factors. With high numbers of overdose deaths from the opioid epidemic, there have been more HCV D+ organs available, leading to transplantation in recipients without HCV (HCV D+/R-) in combination with DAAs. Outcomes in both abdominal and thoracic HCV D+/R transplantation are excellent.SummaryWith recent findings of good outcomes in both HIV D+/R+ and HCV D+/R- SOT, we feel the evidence supports both practices as standard clinical care options to mitigate organ shortage and reduce waitlist mortality.

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“…Another study by the same group involved a discrete choice experiment completed by the staff from 36 OPOs in the United States to quantify the relative importance of donor characteristics on the decision to pursue a theoretical donor. 117 Of the 7 attributes, organ and tissue potential were the most influential; an HIV-positive donor needed to have the potential to donate 2 additional organs to be preferred to an HIV-negative donor.…”

Section: Introductionmentioning

confidence: 99%

Expanding Access to Organ Transplant for People Living With HIV: Can Policy Catch Up to Outcomes Data?

Chandran,

Stock,

Roll

2023

Transplantation

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Advances in antiretroviral and immunosuppressive regimens have improved outcomes following solid organ transplantation in people living with HIV (PLWH). The HIV Organ Policy and Equity Act was conceived to reduce the discard of HIV-positive organs and improve access to transplant for PLWH. Nevertheless, PLWH continue to experience disproportionately low rates of transplant. This overview examines the hurdles to transplantation in PLWH with end-organ disease, the potential and realized impact of the HIV Organ Policy and Equity Act, and changes that could permit expanded access to organ transplant in this population.

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Potential donor characteristics and decisions made by organ procurement organization staff: Results of a discrete choice experiment

Cited by 6 publications

References 33 publications

Deceased Donors With HIV in the Era of the HOPE Act: Referrals and Procurement

Deceased Donors With HIV in the Era of the HOPE Act: Referrals and Procurement

Donors with human immunodeficiency virus and hepatitis C virus for solid organ transplantation: what's new

Expanding Access to Organ Transplant for People Living With HIV: Can Policy Catch Up to Outcomes Data?

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