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.
Between December 2020 and February 2021, the Organ Procurement and Transplantation Network (OPTN) Ad Hoc Disease Transmission Advisory Committee (DTAC) received notice of three donor-derived SARS-CoV-2 transmissions to lung recipients. [1][2][3] In all three cases, the donor prospectively tested negative for SARS-CoV-2 in an upper respiratory tract specimen and retrospectively tested positive in a lower respiratory tract (LRT) specimen. All three lung recipients developed severe coronavirus disease 2019 (COVID-19) including one death, while none of the six recipients of nonlung organs from these donors developed COVID-19. These events signaled an emergent patient safety risk to lung recipients during the COVID-19 pandemic.After review of these sentinel events, DTAC proposed a policy to require pre-transplant SARS-CoV-2 LRT testing by nucleic acid test (NAT) for all deceased lung donors. In early 2021, pre-transplant LRT
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