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

Jason D Goldman; Stephanie M Pouch; Ann E Woolley; Sarah E Booker; Courtney T Jett; Cole Fox; Gerald J Berry; Kelly E Dunn; Chak-Sum Ho; Michelle Kittleson; Dong Heun Lee; Deborah J Levine; Charles C Marboe; Gary Marklin; Raymund R Razonable; Sarah Taimur; Helen S Te; Judith A Anesi; Cynthia E Fisher; Marty T Sellers; Anil J Trindade; R Patrick Wood; Lorenzo Zaffiri; Marilyn E Levi; David Klassen; Marian G Michaels; Ricardo M La Hoz; Lara Danziger-Isakov

doi:10.1111/tid.14013

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

Transpl Infect Dis. 2023 Feb;25(1):e14013. doi: 10.1111/tid.14013. Epub 2023 Jan 24.

Authors

Jason D Goldman^{1

2}, Stephanie M Pouch³, Ann E Woolley⁴, Sarah E Booker⁵, Courtney T Jett⁵, Cole Fox⁵, Gerald J Berry⁶, Kelly E Dunn⁷, Chak-Sum Ho^{8

9}, Michelle Kittleson¹⁰, Dong Heun Lee¹¹, Deborah J Levine¹², Charles C Marboe¹³, Gary Marklin¹⁴, Raymund R Razonable¹⁵, Sarah Taimur¹⁶, Helen S Te¹⁷, Judith A Anesi¹⁸, Cynthia E Fisher², Marty T Sellers¹⁹, Anil J Trindade²⁰, R Patrick Wood²¹, Lorenzo Zaffiri²², Marilyn E Levi²³, David Klassen²⁴, Marian G Michaels²⁵, Ricardo M La Hoz²⁶, Lara Danziger-Isakov²⁷

Affiliations

¹ Organ Transplant and Liver Center, Swedish Medical Center, Seattle, Washington, USA.
² Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA.
³ Emory University School of Medicine, Atlanta, Georgia, USA.
⁴ Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁵ United Network for Organ Sharing, Richmond, Virginia, USA.
⁶ Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.
⁷ Yale New Haven Hospital, New Haven, Connecticut, USA.
⁸ Gift of Hope Organ and Tissue Donor Network, Itasca, Illinois, USA.
⁹ College of Human Medicine, Michigan State University, East Lansing, Michigan, USA.
¹⁰ Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
¹¹ Division of Infectious Diseases, University of California San Francisco, San Francisco, California, USA.
¹² Department of Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA.
¹³ Department of Pathology and Cell Biology, Columbia University New York, New York, New York, USA.
¹⁴ Mid-America Transplant, St. Louis, Missouri, USA.
¹⁵ Division of Public Health, Infectious Diseases and Occupational Medicine and the William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA.
¹⁶ Icahn School of Medicine at Mount Sinai, New York, New York, USA.
¹⁷ Center for Liver Diseases, University of Chicago Medicine, Chicago, Illinois, USA.
¹⁸ Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
¹⁹ DCI Donor Services, Inc., Nashville, Tennessee, USA.
²⁰ Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
²¹ LifeGift Organ Donation Center, Houston, Texas, USA.
²² Department of Medicine, Duke University, Durham, North Carolina, USA.
²³ Division of Transplantation, Health Systems Bureau, Health Resources and Services Administration, Rockville, Maryland, USA.
²⁴ Office of the Chief Medical Officer, United Network for Organ Sharing, Richmond, Virginia, USA.
²⁵ Department of Pediatrics, School of Medicine, University of Pittsburg, Pittsburg, Pennsylvania, USA.
²⁶ Division of Infectious Disease and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
²⁷ Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA.

PMID: 36694448
DOI: 10.1111/tid.14013

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.

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.

Keywords: COVID-19; SARS-CoV-2; donor; safety; transmission; transplantation; utilization.

MeSH terms

Advisory Committees
COVID-19*
Humans
Nucleic Acids*
Organ Transplantation*
SARS-CoV-2
Tissue Donors
Tissue and Organ Procurement*

Substances

Nucleic Acids

Abstract

MeSH terms

Substances

Grants and funding