OPTN required SARS‐CoV‐2 lower respiratory testing for lung donors: Striking the balance

This is the authors' abstract. We don't add key points for this paper.

BetweenDecember 2020 and February 2021, theOrgan Procurement and Transplantation Network (OPTN) Ad Hoc Disease Transmission Advisory Committee (DTAC) received notice of three donor-derived SARS-CoV-2 transmissions to lung recipients.1–3 In all three cases, the donor prospectively tested negative for SARS-CoV-2 in an upper respiratory tract specimen and retrospectively tested positive in a lower respiratory tract (LRT) specimen. All three lung recipients developed severe coronavirus disease 2019 (COVID-19) including one death, while none of the six recipients of nonlung organs from these donors developed COVID-19. These events signaled an emergent patient safety risk to lung recipients during the COVID-19 pandemic. After review of these sentinel events, DTAC proposed a policy to require pre-transplant SARS-CoV-2 LRT testing by nucleic acid test (NAT) for all deceased lung donors. In early 2021, pre-transplant LRT testingwas not common practice for organ procurement organizations (OPOs), with fewer than half of lung donors undergoing LRT testing in February 2021.4 DTAC’s policy development discussion balanced the safety of lung recipients, feasibility for OPOs to implement the required changes to donor testing, and avoidance of undue impact