TABLE 1.

Summary of arguments regarding the use of organs from SARS-CoV-2-positive deceased donors

Use of organs from deceased donors with SARS-CoV-2
	Arguments in support of considering organs	Arguments against considering organs
Clinical	●Potentially lifesaving transplants ●Delays in transplantation from excluding these organs may lead to worse transplant-related outcomes even if patients are ultimately able to be transplanted ●The expanding outbreak may lead to wider interruption of transplant services, limiting future opportunities for many patients ●Waitlist patients are also at risk for COVID-19, and have comorbid conditions associated with increased mortality ●Potential for the discovery of effective treatments, as for influenza, with multiple agents under investigation	●Potential for donor-derived infection (see Table 2) ●Risk that manifestations of infection will be more severe among highly immunosuppressed patients ●Currently no known effective targeted treatment ●Patient isolation may limit frequent care or rapid response to clinical changes. Empiric isolation would be of uncertain duration since the mechanism of donor-derived infection differs from experience with typical respiratory tract inoculation
Systems	●If transplants are shown to be safe in a limited context, the practice could be extended to serve more patients ●Successful transplantation may enable patients with significant healthcare contact (hospitalization, dialysis) to practice social distancing by remaining at home	●Risk of transmission during procurement ●If transmission to the recipient occurs, additional risk of transmission to healthcare workers ●If transmission occurs or recipients are placed in isolation empirically, additional consumption of scarce PPE
Financial	●Supports hospital revenue stream from transplantation when other sources are disrupted	●Reimbursement uncertain when transplantations proceed outside of the national guideline recommendations
Liability	●Higher-than-standard risk, hepatitis C-positive, or hepatitis B-core-positive transplants already occur using a system of informed consent	●If transmission to the recipient occurs, COVID-19 has higher short-term mortality than HIV, hepatitis C, or hepatitis B ●Unfavorable outcomes may result in regulatory review or loss of trust
Ethical	●Honors donor decision to donate ●Honors donor family decision and empowers families to create positive meaning from loss ●Respects the autonomy of patients who desire to proceed with transplantation accepting the theoretical risk ●Can be focused on selected patients to create the most optimal balance of benefits and risks	●If transmission occurs and harms the recipient, this may not be in line with donor or family wishes ●Burdens patients with responsibility for giving informed consent in the context of very limited guidance ●Prioritizes a benefit to 1 patient over possible broader harms ●Exposes healthcare workers to risk that may exceed their duty to patients

Abbreviations: COVID-19, coronavirus disease 2019; HIV, human immunodeficiency virus; PPE, personal protective equipment; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.