OPTN required SARS‐CoV‐2 lower respiratory testing for lung donors: Striking the balance

Abstract

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