A National Survey of Practice Patterns for Accepting Living Kidney Donors With Prior COVID-19

Introduction: A critical question facing transplant programs is if, when and how to safely accept living kidney donors (LKD) who have recovered from COVID-19 infection. The purpose of the study is to understand current practices related to accepting these LKDs. . Methods: We surveyed US transplant programs from September 3 through November 3, 2020. Center level and participant level responses were analyzed. Results: A total of 174 respondents from 115 unique centers responded, representing 59% of US LKD Programs and 72.4% of 2019 and 72.5% of 2020 LKD volume1(Organ Procurement and Transplantation Network-OPTN 2021). 48.6% of responding centers had received inquiries from such LKDs, while 44.3% were currently evaluating. 98 donors were in evaluation phase, while 27.8% centers had approved 42 such donors to proceed with donation. 50.8% of participants preferred to wait > 3 months while 91% would wait at least > 1 month from onset of infection to LD surgery. Most common reason to exclude LDs was evidence of COVID-19 related AKI (59.8%) even if resolved, followed by COVID-19 related Pneumonia (28.7%) and Hospitalization (21.3%). Most common concern in accepting such donors was kidney health post donation (59.2%), followed by risk of transmission to recipient (55.7%),donor perioperative pulmonary risk (41.4%) and donor pulmonary risk in the future (29.9%). Conclusions: Practice patterns for acceptance of COVID-19 recovered LKD showed considerable variability. Ongoing research and consensus building are needed to guide optimal practices to ensure safety of accepting such donors.  Long term close follow up of such donors is warranted.