Introduction: Since the development of antiretroviral therapy (ART), human immunodeficiency virus (HIV) has come to be regarded as a chronic illness. This patient group suffer from a higher incidence of chronic kidney disease (CKD) than patients not living with HIV.
Renal transplantation is the gold standard treatment and may offer a definitive cure of the underlying condition of CKD. Worldwide, the group of donors falls short of the increasing demand for organs, resulting in the death of patients on the transplant waitlist.
Current research findings internationally indicate that HIV+ve individuals who have organ transplants are likely to have similar outcomes to those who are HIV-ve. The Transplantation Society of Australia and New Zealand (TSANZ) Clinical Guidelines from Deceased Donors 2021, states that “the presence of HIV rules out donation in most circumstances”. In Australia presently, the HIV+ve community are currently offered organs from HIV-ve donors.
Method: The first reported case of an organ transplantation between a deceased HIV+ve  donor and HIV+ve  recipient occurred in Australia in 2021.
Supported by international research, the donation and transplant teams navigated these unfamiliar seas. Six months prior an identical HIV+ve potential donor was deemed not medically suitable, fortunately in this case science defeated the current stigma surrounding HIV+ve donors.
Results: An unusual consideration for this donor was not only the HIV+ve status and additional opportunistic infections. Extracorporeal membrane oxygenation (ECMO) was used to provide medical support for the donor. During medical suitability, the donor and recipient were identified as ABO incompatible (ABOi). According to global literature only one other ABOi HIV+ve deceased donor has successfully gone onto organ donation and transplantation.
One month postoperatively, renal function nearly recovered to normal with ongoing surveillance with the recipient transplant team. Sleep integrity and overall physical endurance improved. Today, the recipient has maintained excellent graft function, undetectable viral load, and is doing well in their personal endeavours.  
Conclusion : The complexity of this case remains unprecedented in HIV+ve donors considered for transplantation. With international evidence and our local pioneers pushing the established boundaries, donation and transplantation was achieved in this unsurmountable case.
The first evidence-based guideline for HIV+ve donors and recipients for solid organ donation was established in South Africa. Guideline development is in its infancy in Australia, only a single health institution has a site specific resource, encompassing transplanting organs from HIV+ve donors, recipient eligibility, HIV transmission risks, and addresses ethical barriers. Recent advances in antiretroviral therapy regimen have ensured HIV+ve recipients can be prepared well for transplants.