# Evaluating Challenges in Access To Transplantation for Persons with HIV

## TL;DR

People with HIV face higher mortality from organ failure but have limited access to transplants due to policy, stigma, and logistical issues.

## Contribution

This paper identifies and analyzes multilevel barriers to organ transplantation for people with HIV using a modified five A’s model.

## Key findings

- PWH are less likely to receive organ transplants despite comparable post-transplant outcomes.
- The HOPE Act expanded donor eligibility but challenges like stigma and logistics remain.
- Multilevel interventions are needed to ensure equitable access to transplantation for PWH.

## Abstract

Antiretroviral therapy has significantly improved the life expectancy of people with HIV (PWH), leading to an increased prevalence of comorbidities such as end-stage organ diseases. PWH with end-stage disease face a significantly higher risk of mortality compared to those without HIV, highlighting the urgent need to improve access to organ transplantation for this vulnerable group. This review examines barriers to organ transplantation for PWH, utilizing a modified five A’s model (acceptability, availability, accessibility, affordability, accommodation).

Despite comparable post-transplant outcomes to the general population, PWH are less likely to receive organ transplants. The HIV Organ Policy and Equity (HOPE) Act has expanded the donor pool by permitting organ transplants from donors with HIV to recipients with HIV. However, factors limiting expansion include policy, logistical constraints, and HIV-related stigma.

Despite pivotal advancements in HIV organ transplantation, multilevel challenges continue to limit access for PWH. Addressing these barriers is essential to ensuring equitable access to this life-saving therapy.