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 HIV Organ Policy Equity Act — the HOPE Act — undid the ban in 2013. In 2026, HHS moved to fold HIV-to-HIV transplants into standard practice altogether.
The ban and its undoing
What the HOPE Act does
The HOPE Act, signed by President Obama in 2013, amended federal transplant law to allow organs from HIV-positive donors to be transplanted into HIV-positive recipients — under research protocols governed by HRSA's Organ Procurement and Transplantation Network (OPTN).2
- Applies to deceased HIV-positive donors (originally) and later expanded to include living HIV-positive donors.
- Both donor and recipient must be HIV-positive.
- Requires IRB oversight and reporting to OPTN.
- Transplant centers must be specially approved to participate.
Outcomes so far
Peer-reviewed evidence — much of it from Johns Hopkins, the leading U.S. HOPE Act research center — has shown that HIV-to-HIV kidney and liver transplant outcomes are comparable to HIV-negative to HIV-positive transplant outcomes. Rejection risk is somewhat elevated but manageable with modern immunosuppression and ART.6
The 2026 rule change
In early 2026, the Centers for Medicare and Medicaid Services (CMS) proposed a rule that would further expand access to HIV-positive donor organs. Under the proposal, HIV-to-HIV transplants would move out of research-protocol status and into routine clinical practice, making it easier for transplant centers to accept HIV-positive donor organs and easier for people with HIV to receive them.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
- CD4 count generally > 200 cells/mm³ (varies by center)
- No active opportunistic infection
- Evaluation at a HOPE-approved transplant center
Finding a HOPE-approved transplant center: The Organ Procurement and Transplantation Network maintains a directory of transplant hospitals; the HOPE Act variance list is available at optn.transplant.hrsa.gov.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. ↩
- Federal Register — Final HOPE Act Safeguards and Research Criteria (2020). HHS revision moving HIV-to-HIV kidney and liver transplants toward standard clinical practice. ↩
- Washington Blade — CMS Moves to Expand HIV-Positive Organ Transplants (2026). Reporting on the 2026 CMS proposed rule change. ↩ ↩
- Johns Hopkins — Evolving Evidence in Solid Organ Transplantation for People With HIV. Peer-reviewed synthesis of HIV solid organ transplant outcomes. ↩
- OPTN — Organ Procurement and Transplantation Network. Federal transplant network directory. ↩
- organdonor.gov — Federal organ donor registry. Official U.S. organ donor registration portal. ↩