*Purpose: The OPTN DTAC, a multidisciplinary group, evaluates potential donor derived transmission events (PDDTE) to assess the likelihood of disease transmission.
*Methods: Retrospective study of PDDTE cases reported to the OPTN between 01/2021 and 12/2021. DTAC reviewed cases using a standardized classification algorithm.
*Results: During 2021, there were 18,956 donors and 39,847 recipients. DTAC reviewed 303/329 PDDTE from donor (154) or recipient (175) findings to date, with 329 potential unique transmissions (7 donors had multiple diseases investigated). 64/322 (20%) donors had proven/probable transmission (P/P Tr) of infection (I), malignancies (M), or other to 103/218 (47%) exposed recipients [Figure]. 14 involved living donors. Infection occurred in 49/64 P/P cases affecting 83 recipients. Viruses were most frequent P/P infection with 35 recipients having P/P Tr from 18 donors. HBV and HCV accounted for 35/52 reports including 3 cases of P/P HBV Tr and 3 cases of P/P HCV Tr. COVID-19 PPDTE represented 8% (26/329) of cases; 2 lung recipients had P/P Tr and 0 non-lung recipients had P/P Tr. 27 recipients had P/P bacterial Tr from 17 donors and 20 had P/P fungal Tr from 14 donors. Attributable death (AD) from infection (n=4, 4%) occurred at a median of 47 days (4-151 days) and was highest for fungal infection (2/20, 10%). 11 donors with malignancy were classified as P/P impacting 13 recipients with 0 AD. 7 non-I, non-M PDDTE were reported; 4 resulted in P/P Tr to 7 recipients.
*Conclusions: Although P/P events remain rare, 1/5 reviewed cases resulted in unanticipated P/P Tr with a disease penetrance of 47%. This is a conservative estimate due to passive reporting and empiric interventions. On 5/27/2021, OPTN implemented emergency policy to require SARS-CoV-2 nucleic acid testing on lower respiratory specimens for all lung donors; 0 P/P COVID-19 Tr occurred thereafter. Policy implemented in 03/2021 requiring universal recipient testing for HBV and HCV will allow for improved adjudication of these PDDTE. DTAC continues to evaluate PDDTE to maximize organ utilization and minimize transmission risk.

Stephanie Pouch

OPTN DTAC

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