Utilization and outcomes of deceased donor SARS-CoV-2–positive organs for solid organ transplantation in the United States

Abstract

Coronavirus disease‐19 has had a marked impact on the transplant population and processes of care for transplant centers and organ allocation. Several single‐center studies have reported successful utilization of deceased donors with positive severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) tests. Our aims were to characterize testing, organ utilization, and transplant outcomes with donor SARS‐CoV‐2 status in the United States. We used Scientific Registry of Transplant Recipients data from March 12, 2020 to August 31, 2021 including a custom file with SARS‐CoV‐2 testing data. There were 35 347 donor specimen SARS‐CoV‐2 tests, 77.5% upper respiratory samples, 94.6% polymerase chain reaction tests, and 1.2% SARS‐CoV‐2–positive tests. Donor age, gender, history of hypertension, and diabetes were similar by SARS‐CoV‐2 status, while positive SARS‐CoV‐2 donors were more likely African‐American, Hispanic, and donors after cardiac death (p‐values <.01). Recipient demographic characteristics were similar by donor SARS CoV‐2 status. Adjusted donor kidney discard (odds ratio = 2.08, 95% confidence interval [CI] 1.66–2.61) was higher for SARS‐CoV‐2–positive donors while donor liver (odds ratio = 0.44, 95% CI 0.33–0.60) and heart recovery (odds ratio = 0.44, 95% CI 0.31–0.63) were significantly reduced. Overall post‐transplant graft survival for kidney, liver, and heart recipients was comparable by donor SARS‐CoV‐2 status. Cumulatively, there has been significantly lower utilization of SARS‐CoV‐2 donors with no evidence of reduced recipient graft survival with variations in practice over time.