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

Abstract

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.

Severe acute respiratory syndrome coronavirus 2 positive donors: Improving utilization

“…The manuscript by Goldman, et al. in this issue of Transplant Infectious Diseases ( TID ), provides valuable data describing how from May 27, 2021, to January 31, 2022, the utilization of organs from NAT+ donors was manifest 2 . While this is only a portion of the 2‐year time period when NAT+ donors could have been utilized, this retrospective analysis is the largest, reporting the characteristics and post‐transplant outcomes for 1241 organs from NAT+ donors compared to 21 946 organs from NAT‐ donors.…”

“…How the utilization of extra‐pulmonary organs transpired is of great interest since candidates most in need of transplantation had the most to lose from a testing strategy that could eliminate an organ from the donor pool. Thus, it is important that kidneys, and not hearts or livers, comprised a disproportionately higher number of organs from NAT+ donors 2 . Further, recipients of NAT+ donors had higher median match run sequence and lower disease acuity, with livers going to those with lower median MELD and hearts less likely going to those listed as status 1a or 1b.…”

“…Thus, it is important that kidneys, and not hearts or livers, comprised a disproportionately higher number of organs from NAT+ donors. 2 Further, recipients of NAT+ donors had higher median match run sequence and lower disease acuity, with livers going to those with lower median MELD and hearts less likely going to those listed as status 1a or 1b. Coincidently, NAT+ organs often had excellent measures of organ quality with lower median KDPI and LRDI and similar LVEF than NAT-donors.…”

“…Coincidently, NAT+ organs often had excellent measures of organ quality with lower median KDPI and LRDI and similar LVEF than NAT-donors. 2 These are important markers of transplant center behaviors that may not have effectively balanced the risk of transmission with the recipient's risk for mortality and other F I G U R E 1 Death on the waitlist by time period for heart, liver, kidney, and all combined compared to nucleic acid test (NAT)+ donor transplants. 2,4 complications.…”

“…2 These are important markers of transplant center behaviors that may not have effectively balanced the risk of transmission with the recipient's risk for mortality and other F I G U R E 1 Death on the waitlist by time period for heart, liver, kidney, and all combined compared to nucleic acid test (NAT)+ donor transplants. 2,4 complications. Thus, to assess the true impact of NAT testing and utilization of NAT+ donors, one might also take into account deaths on the waitlist (Figure 1).…”