Confirmed safety of kidney transplant when both recipient and donor are HIV positive

11 January 2026. Related: Journal scan, Early access, Coinfections and complications, Cancer and HIV, Hepatitis coinfection.

Simon Collins, HIV i-Base

Results from a secondary analysis of the US HOPE in Action Study reported no significant differences over two years in the number of infections, mortality from infection, duration or site of infection when kidney donors had been HIV+ (n=99) vs HIV– (n=99), although time to infections was shorter and number of infections was higher then the donor was HIV+. [1]

An accompanying editorial in the 11 January edition of CID, confirmed the safety for people living with HIV to receive transplant organs from recently deceased donors who were also HIV positive (D+R+), noting that this also reduced the time on the transplant waiting list, which disproportionately affects people living with HIV due to faster progression of serious kidney disease. [2]

Since 2016, the US HIV Organ Policy Equity (HOPE) Act allowed D+R+ solid organ transplants as part of a research study. Rates of organ rejection, graft survival, serious adverse events, infections, surgical complications and cancer were all similar to cases when the donor was HIV negative.

In June 2025, the success of the pilot study led to the authorisation of D+R+ transplants across the US outside of research settings.

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Early results from this study were reported in 2024. [3]

Other countries also allow +/+ transplants including living donors. [4]

It also raises the potential for HIV negative people to receive organs from HIV positive donors. This might be an acceptable choice and a life-saving option given HIV is now treatable.

In 2018 South Africa reported the case of an HIV positive mother who donated part of her liver to save the life of her HIV negative child. [4]

References

1. Arant EC et al. Infections After Kidney Transplantation From Donors With Human Immunodeficiency Virus (HIV) to Recipients With HIV, Clinical Infectious Diseases, 2026; ciaf656.  (11 January 2026).
   https://doi.org/10.1093/cid/ciaf656
2. Dhand A and Pouch SM. Infections After Kidney Transplantation from Donors with HIV to Recipients with HIV: Insights, Prevention, and the Path Forward, Clinical Infectious Diseases, 2026; ciaf657. (11 January 2026).
   https://doi.org/10.1093/cid/ciaf657
3. Kidney transplants from HIV positive donors to HIV recipients. HTB (17 October 2024)
   https://i-base.info/htb/49149
4. First successful liver transplant from living donor with HIV/HCV coinfection: surgical video online. HTB (1 June 202).
   https://i-base.info/htb/45603