PURPOSE OF REVIEW: We report the risks and benefits of utilizing HIV-positive organ donors. RECENT FINDINGS: The utilization of HIV-positive organs came with significant concerns including poor organ quality, increased risk of rejection, HIV disease progression, transmission of varying HIV strains and opportunistic infections, virologic failure due to antiretroviral resistance, increased risk for posttransplant malignancy, and recurrent HIV-associated nephropathy. Recently published data have shown, however, that despite the above mentioned risks, patient survival, and graft survival in persons living with HIV (PLWH) who received a kidney transplant from a HIV-positive donor (D+/R+) is similar to a kidney transplant from a HIV-negative donor (D-/R+). SUMMARY: To date, 268 PLWH have received an organ from a HIV-positive donor, including 198 kidney transplants and 70 liver/liver-kidney transplants. The utilization of HIV-positive donor organs has proven to be a safe and feasible approach to expanding the donor pool and improving access to lifesaving therapy for PLWH with end-stage organ disease.