From 1988 to 2013, U.S. federal law made it a crime to knowingly transplant an organ from a person with HIV. That ban — a product of the earliest, most fearful era of the epidemic — meant that even as antiretroviral therapy transformed HIV into a manageable condition, the organs of people living with HIV could not be recovered, and people living with HIV in kidney or liver failure had to wait years longer on the transplant list than everyone else.1
The HOPE Act lifted the federal prohibition in 2013. Research requirements for kidney and liver transplants were removed through the 2024 federal changes, implemented by OPTN on June 26, 2025.[5]
The ban and its undoing
What the HOPE Act does
The 2013 HOPE Act authorized transplantation from donors with HIV to recipients with HIV under research safeguards. Requirements now differ by organ.[5]2
- Both deceased and living donation are possible, with donor assessment and informed consent.
- Both donor and recipient must be HIV-positive.
- Kidney, liver, and liver-kidney transplants no longer require the HOPE research protocol. Other organs remain subject to research requirements.
- Transplant programs must follow applicable OPTN verification and consent safeguards.
Outcomes so far
A 2024 multicenter kidney study compared 99 recipients with HIV who received kidneys from donors with HIV with 99 who received kidneys from donors without HIV. The primary safety outcome met the study’s noninferiority criterion. This supports kidney transplantation in appropriately selected patients; it should not be generalized to every organ or patient.6
The 2024–2025 rule changes
These changes are already implemented for kidneys and livers. Other organs from donors with HIV still require the applicable research pathway. A transplant team can explain which rules apply to your organ and circumstances.5
Who qualifies
If you're living with HIV and in kidney or liver failure, you may be a candidate for a HOPE Act transplant. General eligibility follows standard transplant criteria plus HIV-specific requirements:
- Sustained viral suppression on ART
- Adequate immune function for the particular organ and clinical situation; the transplant team sets the CD4 requirements.
- No active opportunistic infection
- Evaluation by a transplant center experienced in caring for people with HIV
Finding a transplant center: Ask your HIV clinician for a referral to an organ-specific transplant program with HIV experience. OPTN provides transplant resources.7
Registering as a donor: People living with HIV can register as organ donors like anyone else. Register at organdonor.gov.8
References & Sources
HOPE Act legal history, OPTN policy, and peer-reviewed transplant outcomes.
- HRSA — HIV Organ Policy Equity (HOPE) Act overview. Federal explainer of the HOPE Act, including the 1988 ban context. ↩ ↩
- HIV Organ Policy Equity Act (Public Law 113-51). Congressional text of the 2013 HOPE Act. ↩ ↩
- Johns Hopkins Medicine — First HIV-to-HIV Organ Transplants (2016). Announcement of the first HOPE Act transplants in the U.S. ↩
- HHS. Organ Procurement and Transplantation: Implementation of the HOPE Act. Final rule, November 27, 2024. Source. ↩
- OPTN. Revisions to HIV Policies to Align with Federal Regulatory Updates. Effective June 26, 2025. Source. ↩↩
- Durand CM et al. Safety of Kidney Transplantation from Donors with HIV. New England Journal of Medicine, 2024. Source. ↩
- HRSA. Organ Procurement and Transplantation Network. Transplant information and resources. Source. ↩
- organdonor.gov — Federal organ donor registry. Official U.S. organ donor registration portal. ↩