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Although guidance documents have been published regarding organ donation from individuals with a prior history of COVID‐19 infection, no data exist regarding successful recovery and transplantation from deceased donors with a history of or positive testing suggesting a prior SARS‐CoV‐2 infection. Here, we report a case series of six deceased donors with a history of COVID‐19 from whom 13 organs were recovered and transplanted through several of the nation's organ procurement organizations (OPOs). In addition, at least two potential donors were authorized for donation but with no organs were successfully allocated and did not proceed to recovery. No transmission of SARS‐CoV‐2 was reported from the six donors to recipients, procurement teams, or hospital personnel. Although more studies are needed, organ donation from deceased donors who have recovered from COVID‐19 should be considered. [ABSTRACT FROM AUTHOR]

Shah et al err, however, in their pejorative stance toward OPOs undertaking improvement efforts to ameliorate social and demographic factors that challenge donation rates. The delivery of more organs for transplantation, and, specifically, the delivery of double the number of kidneys available for transplantation by 2030, is a much-needed and highly challenging executive marching order to US organ procurement organizations (OPO).1 To respond effectively, objective, standardized measures of organ donation which have, heretofore, not been utilized are required. All transplant candidates are served by the same donation infrastructure.16 All OPOs must engage in broad efforts to mitigate these national-level challenges that now directly limit their own, local patients' access to organs. [Extracted from the article]

For health providers guiding the end-stage renal disease patient's care, conventional surgical and anesthetic principles may demand substantial modifications to optimize both the immediate outcome and long-term survival. Elective operation is conducted in the setting of optimized acid/base balance, volume status and potassium management with pre-operative dialysis completed within 24 hours of the procedure (either hemodialysis or peritoneal dialysis). When peripheral intravenous access is inadequate, central venous access is obtained preferentially through the internal jugular veins because of the catastrophic consequences of catheter-induced subclavian stenosis. Infectious prophylaxis incorporates antibiotic selection considering the lack of native renal drug clearance, the potential for drug loss across dialysis membranes and potential interactions with immunosuppressive medications. Judicious intraoperative blood and fluid replacement should not be so restricted as to permit inadequate end organ perfusion, even if post-operative dialysis is necessitated. Hemostasis may be facilitated by the use of desmopressin to correct uremic platelet dysfunction. Wound closure techniques should accommodate the delayed healing associated with kidney failure and/or iatrogenic immunosuppression. [ABSTRACT FROM AUTHOR]

Background: Multidrug‐resistant (MDR) and extensively drug‐resistant (XDR) gram‐negative bacteria may be transmitted from organ donors to solid organ transplant recipients and are associated with poor outcomes post‐transplant. Methods: We reported the prevalence of MDR/XDR gram‐negative respiratory colonization among 702 deceased organ donors in the New York City area from 2011 to 2014 and performed chart reviews for a subset of recipients to determine whether donor respiratory culture results were predictive of subsequent recipient infection or used to guide post‐transplant antimicrobial therapy. Results: Fifty donors (7% of the cohort) had MDR or XDR gram‐negative bacteria isolated from endotracheal aspirate or bronchoalveolar lavage culture. Organs from these 50 donors were transplanted into 120 recipients; chart review was performed for 89 of these recipients (38 kidney, 32 liver, 11 heart, 6 kidney/pancreas, 1 liver/kidney, 1 lung). None of the 89 recipients of organs from donors with MDR/XDR gram‐negative respiratory colonization were reported to have a donor‐derived infection post‐transplant, and chart review for the 88 non‐lung recipients indicated that peri‐transplant antibiotics were not adjusted specifically for donor respiratory culture results. Conclusion: These results suggest that donor respiratory culture results are not predictive of post‐transplant infection in non‐lung recipients and are unlikely to impact post‐transplant management. [ABSTRACT FROM AUTHOR]