Introduction: Due to unknown transmission risks, donors with acute COVID-19 infection manifested by positive PCR test were ineligible for organ donation in the past. We report our experience with 6 donors with acute COVID-19 infection whose organs were used for transplantation.

Methods: Retrospective review of outcomes of transplantation from COVID-19 positive donors.

Results: Organs from six brain dead donors were utilized for transplantation. Donors were tested with COVID-19 PCR either on nasopharyngeal swabs or Brochoalveolar lavage specimens or both. Heart, liver and kidney were used for transplant from 1 donor, heart was utilized from 2 and liver from 3 of the donors. Three donors had discrepancy in results with a negative nasopharyngeal PCR, but positive BAL specimen. One donor had symptomatic COVID-19 infection (pneumonia) and all others were asymptomatic. Cycle threshold was >25. Recipients included 3 heart transplant, 3 liver transplant and 1 combined liver-kidney transplant. All recipients had completed full vaccination series, and three received additional post transplant pre-exposure prophylaxis with Tixagevimab/Cligavimab. Standard post transplant immunosuppression with steroids, CNI and antimetabolite was used. Two heart transplant recipients underwent post transplant treatment for AMR. There were no post transplant COVID infections with of median follow up of 40 days. All patients and grafts are doing well.

Conclusion: Successful transplantation of organs from donors with COVID-19 infection is feasible. Appropriate donor and recipient selection and risk assessment is essential and long term follow up to rule out any transmittable risks of donor derived infection.