Spain repeals 1987 regulation and allows organ transplants from HIV+ donors.

In a significant shift towards inclusion and the expansion of opportunities for HIV patients, Spain has decided to repeal a 1987 regulation that prohibited the use of organs from HIV-positive donors. This measure, announced by the Ministry of Health coinciding with World AIDS Day, reflects a change in perspective regarding HIV and its implications in the field of transplants, aligning with practices already adopted in other countries where organ donation by HIV+ individuals has proven to be safe and effective. This decision comes in a context where knowledge about HIV has notably advanced since the early days of the pandemic, when the virus was seen as a death sentence. In the 1980s, misinformation and fear led to the creation of barriers that excluded many potential donors, including those whose only "fault" was being part of the LGBTQ+ community or having a history of intravenous drug use. The 1987 regulation emerged in a climate of uncertainty and alarm, drastically restricting donation opportunities and, consequently, limiting transplant options for those who needed them most. The paradigm shift now emerging in Spain has been driven by a better understanding of HIV and the development of antiretroviral treatments that allow individuals to live with quality and longevity. Since transplants began for HIV+ patients in Spain in 2001, there has been a significant increase in the number of these procedures, demonstrating that medical advances have surpassed the unfounded fears of past decades. Data reveals that more than 800 HIV+ patients have received transplants of various organs in the country, with a notable predominance of liver transplants. Although the number of HIV+ donors is still limited, as it is estimated that approximately 40 people per year receive a transplant in this context, the new regulation could open the door for many more. In the last decade, 65 donors were rejected due to their HIV-positive status, indicating that this is an aspect that had remained in the shadows and can now begin to be addressed differently. International experience has shown that transplant outcomes between HIV+ patients and organs from HIV+ donors have been encouraging. In countries like the United States and South Africa, these practices have been successfully carried out, encouraging others to follow suit. The repeal of the regulation in Spain is presented not only as an advancement in translational medicine but also as a step towards the normalization and destigmatization of HIV infection in society. Although the number of transplants that can be performed with this new approach may be limited, every saved life counts. The National Transplant Organization (ONT) has estimated a potential of up to 38 annual transplants that could be carried out with HIV+ donors, underscoring the importance of removing this legal barrier. This could offer hope to those on waiting lists who might otherwise lack access to a compatible organ. From a broader perspective, this decision also symbolizes a cultural and social change regarding how organ donation and HIV are approached. The ONT has advocated for years that donation should not only be seen as an act of generosity but also as a right that everyone should be able to exercise. With the repeal of this regulation, the possibility arises for more people to feel comfortable and motivated to donate, thus contributing to a more equitable and just healthcare system. However, challenges persist. The search for matches between donors and recipients in small groups with specific requirements remains an obstacle. Nevertheless, the decision to consider HIV+ donors is a crucial step towards integrating this population into the transplant system, and it is hoped that it will help dismantle the stigma associated with HIV. In conclusion, the repeal of this regulation in Spain not only represents a legal change but also reflects a social advancement towards inclusion and acceptance of all individuals, regardless of their health status. This movement could mean the salvation of lives and the improvement of the quality of life for many patients, marking a milestone in the history of organ transplantation and the fight against HIV stigma. With each step, the moment approaches when donation and transplantation are seen simply as medical options, stripped of prejudice and unfounded fears.