October’s Article of the Month, with commentary from Dr. Cale Kassel, analyzes SRTR registry data from March 2020 through August 2021 — the first 18 months of the pandemic — to evaluate how SARS-CoV-2-positive deceased donors were used (or not used) across U.S. solid organ transplantation. Despite comparable post-transplant graft survival for kidney, liver, and heart recipients regardless of donor SARS-CoV-2 status, COVID-positive organs were recovered and transplanted at significantly lower rates — suggesting an opportunity to safely expand the donor pool.
Key Findings
- Dataset: 35,347 donor SARS-CoV-2 tests via SRTR (March 2020 – August 2021); 94.6% PCR, 1.2% positive
- Donor demographics: Positive donors were more likely to be African-American, Hispanic, or DCD; age, sex, hypertension, and diabetes were similar across groups
- Reduced organ recovery from positive donors: liver (OR 0.44) and heart (OR 0.44) recovery significantly lower; kidney discard rate higher (OR 2.08)
- Recipient outcomes were comparable regardless of donor SARS-CoV-2 status:
- Kidney graft survival: 95.5% (positive) vs. 95.3% (negative)
- Liver graft survival: 93.9% vs. 97.0%
- Heart graft survival: 92.8% vs. 96.7%
- Practice evolved over time: Kidney discard rate for COVID-positive donors dropped in the later study period (Dec 2020 – April 2021) compared to the early pandemic, though still elevated overall
- Clinical implication: Early registry-level data support the safe use of SARS-CoV-2-positive grafts in selected recipients — potentially expanding access without compromising survival, while practice continues to evolve as understanding matures
