*Purpose: Rapid evolution of the SARS-CoV-2 pandemic over the past 24 months has demanded agility in managing selection criteria for deceased organ donors, with the goal of saving every possible life while avoiding disease transmission to recipients. At 1 large organ procurement organization (OPO), the detection of any SARS-CoV-2 in a naso-pharyngeal (NP) specimen by polymerase chain reaction (PCR) was initially an absolute contraindication to organ donation. That approach gradually became more refined utilizing clinical evidence along with detection of low levels of viremia.

*Methods: A retrospective analysis of all patients with authorization for organ donation after brain death or circulatory death from 3/16/2020 – 11/9/2021 was undertaken. Patients with any positive result for a COVID-19 test were identified. Donors with any positive result of an NP +/- broncho-alveolar fluid (BAL) PCR were selected for this analysis. Organ allocation was accompanied by the expectation of written confirmation that the recipient had provided informed consent for use of an organ from a SARS-CoV-2 donor.

*Results: A total of 18 deceased donors from whom 49 organs were transplanted, were identified. Multiple test results were often available for a single patient. Results were mixed in all 18 donors. At least one of the positive NP PCR test results included a cycle threshold in 16/18 patients and ranged from 31.4 to 42.5. In 2 donors a BAL PCR was also positive; 1 heart was donated from one of these donors. With a follow-up of > 53 days for all transplants, no known transmission of SARS-CoV-2 to recipients or transplant teams has been reported.

*Conclusions: Available laboratory testing for SARS-CoV-2 and deepening understanding of COVID-19, increasing treatment options, and evolution of infection prevention practices have facilitated a growing confidence in safely transplanting non-lung organs from donors with a positive SARS-CoV-2 test.

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