S. 330: HIV Organ Policy Equity Act
Legislation
On February 14, 2013, the S. 330: HIV Organ Policy Equity Act (HOPE) Act was introduced by
bipartisan legislators to both the House and the Senate (Cray, 2013). The Senate passed the Act by
unanimous consent on June 17, 2013, and the Act is now waiting to be sent to the House for
consideration (govtrack.us, 2013). The bill would remove the provision that prohibits the acquisition and
procurement of donated organs that are infected with human immunodeficiency virus (HIV). The HOPE
Act would amend the Public Health Service Act and require the Department of Health and Human
Services (HHS) to develop and introduce safe standards for research on HIV-positive organ
transplantation in HIV-positive organ recipients (Human Rights Campaign, [HRC], 2013). Upon yearly
review, the Secretary of HHS will have the ability to implement positive-to-positive organ
transplantation if it is determined by the research that this change in organ transplantation is warranted
(HRC, 2013). If HIV organ research does support positive-to-positive transplantation, the Organ
Procurement Transplant Network (OPTN) will be required to develop safe and secure standards for the
transplantation process to ensure that the new transplantations do not impact the safety and integrity
of the organ transplantation network. Organs infected with HIV may only be transplanted into
individuals who are also infected with HIV. The research that would be allowed through the HOPE Act
could establish new a health policy that is consistent with the current medical and scientific
advancements, and ultimately allow science to guide Federal standards (Cray, 2013).
Fixing the Problem
Currently, organ donation from a deceased HIV-positive individual for transplantation to an HIVpositive patient is a medical procedure that is illegal under Federal law. As medical advancements and
treatments for HIV/AIDS-positive victims have improved, individuals are living longer, and like other
older Americans, are developing medical conditions that may require an organ transplant. The new Act
could help replace outdated organ donation policies, lift the ban on HIV-organ transplantation research,
and increase the number of lives saved by organ donations (Cray, 2013). The bill would open pathways
for new research, standards, and transplantation policies that will change people’s lives, and would
positively alter the direction of organ transplantation. The number of organs needed, far exceeds the
number of organs available for transplant. Allowing organs from HIV-positive donors to be transplanted
into HIV-positive individuals awaiting transplants has the potential to save thousands of lives. This
change would not only improve the wait time for an organ for HIV patients, but would also shorten the
wait time for non-HIV patients as well (Cray, 2013). It is estimated that nearly 100,000 patients are
actively waiting for an organ, and about 50,000 new patients are added to the list each year (HRC, 2013).
Permitting organs from an HIV-positive individual to be transplanted into an HIV-positive patient is
estimated to save around 500 to 1,000 HIV-infected kidney and liver patients each year (HRC, 2013). In
turn, patients who are not living with HIV would receive transplants faster because HIV-positive
recipients will be able to obtain organs that would otherwise be discarded under current policy (Cray,
2013). The Act may also help break down social barriers and negative stereotypes that have been
perpetuate regarding HIV and AIDS.
The National Organ Transplant Act was established during a time when HIV/AIDS was not
completely understood. Transmission of HIV/AIDS during this time was still a mystery, so specific
standards were put in place to ensure no organs from individuals who were known to be infected with
HIV were harvested. Since 1984, the medical community has gained a much better understanding of
HIV, especially regarding the transmission of the disease, which makes the current policies of discarding
HIV-positive organs discriminatory and ultimately obsolete. Case in point; under the current standards,
individuals who have tested positive for Hepatitis C are allowed to donate organs to other individuals
with Hepatitis C. It now seems quite logical that the same should be allowed for HIV-infected individuals
(Cray, 2013). Long transplant wait times and limited organ options for both HIV-positive and HIVnegative patients mean lives are unnecessarily lost under the old legislation. The HOPE Act will certainly
alleviate these problems for those infected with HIV, and those who are not.
Legislation Problems
Research revealed that no groups or individuals were opposed to this legislation. Safeguards of
transplant organs and advances in the treatment of the HIV/AIDs virus will allow for a better public
perception of transplanting organs from an HIV donor. There are major medical groups showing
unanimous support, as the HOPE Act has the potential to save many lives by making more organs safely
available for transplant. The Act is supported by dozens of organizations that advocate on transplant
policy and communities with an increased need for transplantation, including AIDS United, amfAR,
American Medical Association, American Society for Nephrology, Association of Organ Procurement
Organizations, American Society of Transplantation, American Society of Transplant Surgeons, Dialysis
Patient Citizens, HIV Medicine Association, and United Network for Organ Sharing (UNOS) (Human
Rights Campaign, 2013).
Although opposition to the passage of the HOPE Act has been difficult to find, it is not difficult to
imagine what opponents might fear. Since HIV/AIDS is such a serious and life-threatening disease, there
is no room for mistakes involving infected organ transplantation. The Secretary of the DHHS and the
OPTN must institute guidelines that address all possible mistakes that might be made in the removal,
transfer, and final location of these infected organs. Opponents may argue that the potential for
mistakes in labeling or handling could contribute to the infection of additional HIV-negative persons if
they receive infected organs. Unfortunately, mistakes in hospitals do occur and can therefore result in
life-or-death consequences for patients (Feijter, Grave, Muijtjens, Scherpbier, & Koopmans, 2012). This
potential problem would certainly give opponents of the bill a valid argument regarding the safety of
HIV organ transplant programs.
Expected outcomes
With the passing of the HOPE Act, there will be an amendment to the federal criminal code
which would “declare that an organ donation does not violate the prohibition against a knowing organ
donation by an HIV-infected individual if the donations made in accordance with this Act” (HIV Organ
Policy Equity Act, 2013). The expected outcomes include reduced wait times for both HIV-positive and
negative patients, as well as improved quality of life for these recipients. The Act will reduce the
currently wasteful nature that has prevailed for decades. No longer will viable HIV-positive organs be
discarded. Rather, if the research is successful, they will be put to use within those whose futures
depend upon timely organ transplantation.
Unexpected Outcomes
This legislation represents a positive step forward for sensible HIV and health policy. It removes
outdated barriers to common-sense, and promotes data-driven procedures for the donation of lifesaving organs. With any change, there will be natural and logical consequences, both positive and
negative. There are some unanticipated events that could arise as a result of this bill being passed.
Currently, HIV-positive individuals can receive organ transplants, but are prevented from participating in
organ donation. Intensive and ongoing research will most likely demonstrate that organ transplants
between HIV-positive donors and HIV-positive recipients are safe and successful.
Another outcome resulting from the passing of this legislation is evidence of data-driven science
replacing discriminatory stereotypes. The National Organ Transplant Act of 1984, which established
standards for organ donation, was passed at the height of anti-gay rhetoric and widespread
misunderstanding surrounding HIV/AIDS, and reflected the notions of the time. It prevented the
acquisition of organs from individuals known to be infected with HIV. The effect of the current prohibits
the acquisition of organs from HIV-positive donors, while hundreds of HIV-positive people in need of
donated organs languish on long transplant waitlists. Despite significant advances in testing, screening,
and transmission prevention, these organ-donation restrictions have endured. They are vestiges of
antiquated bias and misinformation, and no longer align with the progress made in medical technology
and public health policies (Cray, 2013).
The Hope Act could also save on Medicare expenses. Removing barriers to the donation of safe,
viable organs is also good fiscal policy. Patients with kidney failure are covered as part of the Medicare
End Stage Renal Disease Program. This program makes up a little less than $20 billion of the overall
Medicare budget (Cray, 2013). By providing healthy transplant organs to these patients, the
transplantation process can prevent some of these costs. If restrictions on organ donations between
HIV-positive individuals were lifted under the HOPE Act, these costs would be decreased by $500,000
per patient (Cray, 2013).
Recommendations
The HOPE Act in its current form seems both logical and solid. Research involving the
transplantation of HIV-infected organs into HIV-positive patients means that thousands of organs will
not be wasted and thousands of lives can be improved. HIV-positive patients will be afforded the
opportunity to receive the needed organs which will reduce wait times for both HIV-positive and
negative recipients. It will, however, be extremely important that the Secretary of the DHHS puts into
place effective regulations for removal, transportation, and final patient destination of the infected
organs. We recommend a Chain-of-Custody approach in which the organs are tracked by signatures and
contents verified when transferred from individual to another. Successfully tracking the infected organs
is of the utmost importance if the program established by Secretary is to be safe, as well as successful.
The HOPE Act seems to be a winning formula for all. Because of this, there are no modifications that
need to be made to the Act. It opens the door to a multitude of positive outcomes that society as a
whole should embrace. It will indeed bring hope to the thousands of Americans awaiting an organ
transplant.
References
Cray, A. (2013). Public-health advocates should support the HIV Organ Policy Equity Act. Center for
American Progress. Retrieved from
http://www.americanprogress.org/issues/healthcare/news/2013/03/11/56117/public-healthadvocates-should-support-the-hiv-organ-policy-equity-act/
Feijter, J., Grave, W., Muijtjens, A. M., Scherpbier, A. A., & Koopmans, R. P. (2012). A comprehensive
overview of medical error in hospitals using incident-reporting systems, patient complaints and
chart review of inpatient deaths. Plos ONE, 7(2), 1-7. doi:10.1371/journal.pone.0031125
Govtrack.us. (2013). S. 330: HIV Organ Policy Equity Ac. Retrieved from
http://www.govtrack.us/congress/bills/113/s330
Human Rights Campaign. (2013). HIV Organ Policy Equity (HOPE) Act. Retrieved from
http://www.hrc.org/laws-and-legislation/federal-legislation/hiv-organ-policy-equity-hope-act
Levario, A. (2013). Senate passes HIV Organ Policy Equity Act. Human Rights Campaign. Retrieved from
http://www.hrc.org/blog/entry/senate-passes-hiv-organ-policy-equity-act
S. 330--113th Congress: HIV Organ Policy Equity Act. (2013). In www.GovTrack.us. Retrieved June 24,
2013, from http://www.govtrack.us/congress/bills
U.S. Department of Health & Human Services. Organ procurement and transplantation network. (2013).
Retrieved from http://optn.transplant.hrsa.gov/