OPTN Required SARS-CoV-2 Lower Respiratory Testing for Lung Donors: Early Impact on Patient Safety and Organ Utilization

S. E. Booker¹, C. Martinez¹, C. Fox¹, C. Jett¹, D. Klassen¹, L. Danziger-Isakov², R. M. La Hoz³

¹UNOS, Richmond, VA, ²Cincinnati Children's Hospital Medical Center, Cincinnati, OH, ³University of Texas Southwestern Medical Center, Dallas, TX

Meeting: 2022 American Transplant Congress

Abstract number: 269

Keywords: COVID-19, Lung, Public policy, Safety

Topic: Clinical Science » Public Policy » 21 - Non-Organ Specific: Public Policy & Allocation

Session Information

Session Name: Non-Organ Specific: Public Policy & Allocation

Session Type: Rapid Fire Oral Abstract

Date: Monday, June 6, 2022

Session Time: 3:30pm-5:00pm

Presentation Time: 4:50pm-5:00pm

Location: Hynes Room 311

*Purpose: The OPTN implemented emergency policy on 5/27/21 requiring lower respiratory testing (LRT) by nucleic acid test (NAT) for SARS-CoV-2 (COVID-19) for all potential deceased lung donors. Our objective was to assess the policy’s impact on organ utilization and patient safety.

*Methods: OPTN data were analyzed for LRT information reported in discrete data fields or attachments in DonorNet for deceased lung donors recovered 5/27/21-10/31/21. We used natural language processing to identify donor attachments with terminology related to COVID-19 (e.g., “COVID”, “SARS-COV-2”) and LRT (e.g., “BAL”, “tracheal aspirate”) in the attachment filename or description.

*Results: In the first 5 months since implementation, lungs were transplanted from 1037 donors (963 (92.9%) non-DCD, 74 (7.1%) DCD) (Figure). Lung utilization decreased slightly from pre- to post-policy for both non-DCD and DCD donors (overall: 17.7% vs 16.2%; non-DCD: 22.9% vs 21.7%; DCD: 5.1% vs 3.8%). 99.8% (N=1035/1037) of transplanted lung donors had LRT; the majority (99.2%) had LRT results reported in DonorNet on/before day of lung transplant. There have been no reported potential donor-derived SARS-CoV-2 transmissions to lung recipients since implementation. 58 donors had a positive LRT (LRT+), including 27 (46.6%) with a negative upper respiratory test. Lungs were not transplanted from 57/58 LRT+ donors; 1 LRT+ donor was believed to be a false positive based on confirmatory test results and had lungs transplanted. Non-lung organs were recovered and transplanted from LRT+ donors without evidence of disease transmission (Table). While the kidney discard rate was higher for LRT+ donors relative to donors without LRT+ (30.2% vs 24.8%), liver discards were lower (5.6% vs 9.9%), and heart utilization was similar (27.6% vs 28.0%).

*Conclusions: Early results suggest that the LRT policy has minimized the risk of donor-derived COVID-19 transmission to lung recipients with minimal impact on lung utilization and allowing transplantation of non-lung organs from LRT+ donors.

To cite this abstract in AMA style:

Booker SE, Martinez C, Fox C, Jett C, Klassen D, Danziger-Isakov L, Hoz RMLa. OPTN Required SARS-CoV-2 Lower Respiratory Testing for Lung Donors: Early Impact on Patient Safety and Organ Utilization [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/optn-required-sars-cov-2-lower-respiratory-testing-for-lung-donors-early-impact-on-patient-safety-and-organ-utilization/. Accessed November 21, 2024.

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