Transplant of organs from donors with positive SARS-CoV-2 nucleic acid testing: A report from the organ procurement and transplantation network ad hoc disease transmission advisory committee.
Transplant infectious disease : an official journal of the Transplantation Society
washington, swedish, covid-19
BACKGROUND: Decisions to transplant organs from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid test-positive (NAT+) donors must balance risk of donor-derived transmission events (DDTE) with the scarcity of available organs.
METHODS: Organ Procurement and Transplantation Network (OPTN) data were used to compare organ utilization and recipient outcomes between SARS-CoV-2 NAT+ and NAT- donors. NAT+ was defined by either a positive upper or lower respiratory tract (LRT) sample within 21 days of procurement. Potential DDTE were adjudicated by OPTN Disease Transmission Advisory Committee.
RESULTS: From May 27, 2021 (date of OTPN policy for required LRT testing of lung donors) to January 31, 2022, organs were recovered from 617 NAT+ donors from all OPTN regions and 53 of 57 (93%) organ procurement organizations. NAT+ donors were younger and had higher organ quality scores for kidney and liver. Organ utilization was lower for NAT+ donors compared to NAT- donors. A total of 1241 organs (776 kidneys, 316 livers, 106 hearts, 22 lungs, and 21 other) were transplanted from 514 NAT+ donors compared to 21 946 organs from 8853 NAT- donors. Medical urgency was lower for recipients of NAT+ liver and heart transplants. The median waitlist time was longer for liver recipients of NAT+ donors. The match run sequence number for final acceptor was higher for NAT+ donors for all organ types. Outcomes for hospital length of stay, 30-day mortality, and 30-day graft loss were similar for all organ types. No SARS-CoV-2 DDTE occurred in this interval.
CONCLUSIONS: Transplantation of SARS-CoV-2 NAT+ donor organs appears safe for short-term outcomes of death and graft loss and ameliorates the organ shortage. Further study is required to assure comparable longer term outcomes.
Goldman, Jason D; Pouch, Stephanie M; Woolley, Ann E; Booker, Sarah E; Jett, Courtney T; Fox, Cole; Berry, Gerald J; Dunn, Kelly E; Ho, Chak-Sum; Kittleson, Michelle; Lee, Dong Heun; Levine, Deborah J; Marboe, Charles C; Marklin, Gary; Razonable, Raymund R; Taimur, Sarah; Te, Helen S; Anesi, Judith A; Fisher, Cynthia E; Sellers, Marty T; Trindade, Anil J; Wood, R Patrick; Zaffiri, Lorenzo; Levi, Marilyn E; Klassen, David; Michaels, Marian G; La Hoz, Ricardo M; and Danziger-Isakov, Lara, "Transplant of organs from donors with positive SARS-CoV-2 nucleic acid testing: A report from the organ procurement and transplantation network ad hoc disease transmission advisory committee." (2023). Articles, Abstracts, and Reports. 7014.