*Purpose: Until recently, donor COVID positivity was seen as a contraindication for donation or transplantation. Our OPO has recently adopted a practice in which organs from COVID positive donors could be offered for transplantation if they presented greater than 10 days after onset of symptoms.

*Methods: We reviewed our database for COVID positive organ donors from 2/1/21 to 11/1/21. A total of 11 donors were examined, of which 5 met criteria DCD and 6 were brain dead (DBD). UNET was reviewed to determine donor demographics, clinical presentation, and WIT

*Results: Of the 5 COVID positive DCD donors, only 3 kidneys were placed from 2 donors (Table 1) for an OTPD = 0.60. Four of the 5 donors died of complications of COVID. Of the 3 DCD donors where no organ was placed, the local list was exhausted and aggressive centers were contacted at the time of organ offer. No DCD COVID positive livers were placed. Sequence placement ranged from #671 to #7829. COVID negative DCD donors resulted in OTPD = 1.81. Of the 6 COVID positive DBD donors (Table 2), a total of 10 kidneys, 1 pancreas, 3 hearts, and 4 livers were placed for an OTPD of 3.00. None of the 6 donors died of complications of COVID. Five of the 6 donors presented with negative nasopharyngeal swabs but were later positive on repeat NP swab, tracheal aspirate, or BAL. The 6th donor had a history of symptomatic COVID one month prior to brain death and was persistently PCR positive on NP swab. All COVID positive kidneys, the pancreas, 1 of the 3 hearts, and 2 of the 4 livers were placed within our UNOS region. Sequence placement ranged from #1 to #2676. COVID negative DBD donors during the same time resulted in OTPD = 3.24.

*Conclusions: Our early analysis demonstrated several low-KDPI DCD organs with short WIT that went unused, while DBD organs with COVID positivity were used at nearly the rate of non-COVID DBD donors. We did not place any COVID positive DCD extra-renal organs. Our COVID DBD donors were placed at nearly the same rate as non-COVID, albeit at higher sequence. We believe that DCD donors that are COVID positive reflect an underutilized source of transplantable organs. Further investigation should be undertaken on a broader scale to encourage utilization of these organs and to study their short-and long-term outcomes.

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