The rules governing organ procurement, patient eligibility, ranking of wait lists and accreditation of hospitals that can perform transplants are extremely complex in the United States, and until recently the use of organs from HIV-positive individuals had been illegal.

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That changed with the passage of the HIV Organ Policy Equity Act or HOPE Act, which was signed into law in late 2013. In lobbying for the bill, experts had emphasized that approximately 122,000 people are on the transplant list at any given point in time and thousands die each year while still waiting.

Supporters of the law like Segev, who helped draft the bill, estimated that as many as 600 new transplants could be made possible by using organs from HIV-positive donors for HIV-positive recipients and that this would shorten transplant lists for both HIV-positive and HIV-negative patients.

Johns Hopkins said it is ready to perform the transplants immediately as soon as patients are identified and hopes to be the first in the world to perform an HIV-positive to HIV-positive liver transplant and the first in the country to do an HIV-positive to HIV-positive kidney transplant. South Africa has been allowing HIV-positive to HIV-positive kidney transplants for several years and has seen positive outcomes.

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The 2013 law directed the Department of Health and Human Services and the United Network for Organ Sharing, a nonprofit scientific group that was established by Congress in 1984, to manage the process and to revise policies on testing, transport and other protocols to ensure the safety of the recipient.

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