Introduction: Early on in the pandemic, COVID-19 was a rule-out for organ donation. The development of protocols to best screen potential organ donors was necessary to continue to provide life-saving organ transplants while minimizing the risks of COVID-19 transmission.

Method: This was a single OPO, multi-center observational study. The OPO initiated SARS-CoV-2 testing by lower respiratory (tracheal aspirate) specimens for all potential deceased organ donors and worked with 2 local labs that together could perform testing 24 hours a day and return results including Cycle Threshold (CT) within approximately 6 hours.

Results: Between 1/1/2021 and 2/28/2022, 572 (8.7%) of the 6570 vent-dependent patients with non-survivable neurological injuries referred to the OPO tested positive for SARS-CoV-2 by upper respiratory specimen (typically performed by the referring hospital lab) or by lower respiratory specimen (performed by the OPO affiliated lab).  Of the 572 COVID+ patients, 480 were determined to be medically unsuitable and in 42 cases the NOK declined organ donation. Of the 57 patients that went on to become organ donors, the CT ranged from 16.3 to 43.1, and 78 kidneys, 34 livers, 11 hearts and 2 pancreas were transplanted at 38 transplant centers. No suspected transplant related disease transmissions were reported.

Conclusion: Continued referral and assessment of all potential organ donors throughout the pandemic regardless of SARS-CoV-2 infection status, along with improved and timely access to lower respiratory testing including CT results led to the successful utilization of organs from COVID-19+ donors for transplant.