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It's needed for situations similar to this post: http://stackoverflow.com/questions/7296642/django-understanding-x-sendfile

I currently have websites that utilize this and not sure if I can migrate them from Apache (+ mod_wsgi).

I've done tests with sendfile() in the past and seen that it doesn't make things faster. It also breaks things in Hiawatha, like upload throttling, and doesn't work with SSL. So, sorry, but Hiawatha will not have support for X-Sendfile. But don't worry, the absent of this feature won't break any client. In other words, this won't interfere with any migration plans.