Table 1.

Donor and Recipient Characteristics

	Donor					Recipient
Subject	Organ	Donor with clinically moderate or severe COVID-19?aDonor vaccinated?	Donor information?Cause of death?	Donor COVID testb (days prior to procurement)	Donor heart EF at procurement>55%?c	Number of mRNA vaccine doses prior to transplant	Recipient indication for transplant?Waitlist allocation score?	Recipient develop COVID-19?Treatment?	Graft function?d	SARS-CoV-2 PCR detected on tissue biopsy?	Days since transplant and current recipient status
1	Heart	No; Not vaccinated	23 years male, no medical history Motor vehicle accident	D-3: tracheal aspirate PCR +, CT = 38.14. D-2: tracheal aspirate PCR + D-1: tracheal aspirate –; NPS –	Yes	Unknown	53 years male, HCM Status 2	No	1R, pAMR 0 EF >55%	N/A	D+351, discharged home
2	Heart	No; Unknown vaccination status	32 years male, history of substance abuse; Suspected opioid overdose	D-2: NPS+, CT = 34	Yes	2	62 years male, NICM Status 2	No	2R, pAMR 0 EF >55%	Negative	D+253, discharged home
3	Heart	No- asymptomatic; Unknown vaccination status	24 years male; no medical history Drug overdose	D-5: NPS +, D-2: BAL +, CT = 13.26; NPS +, CT = 16.1.	Yes	2	69 years male; NICM Status 2	No; received monoclonal antibody post exposure prophylaxis	1R, pAMR 0 EF >55%	Negative	D+237, discharged home
4	Heart & Liver	No- mild symptoms of headache; Not vaccinated	20 years male; history of depression; Cerebral abscess	D-7: NPS +, CT = 41.9; NPS antigen –; BAL –	Yes	2	36 years male; congenital heart disease with double inlet left ventricle, AV atresia, VSD) Status 4	No	Severe biventricular graft dysfunction	Negative	Transplant complicated by massive hemorrhage followed by hypercoagulability and coronary thrombus requiring redo heart transplant on D+6.
4	Heart	No-asymptomatic; Unknown vaccination status	17 years male; no medical history; Suicide, gunshot wound	D-17: NPS + D-5: NPS +, CT = 26 D-3 NPS +, CT = 20-21 and BAL +, CT for ORS gene = 32.7, CT for S gene = 39.0	Yes	2	Indication as above Status 1	No	1R, pAMR 0 EF >55%	N/A	D+88 deceased; primary cause of death: hemorrhagic shock from aortic anastomosis breakdown and Rhizopus mediastinitis
5	Heart	No; Unknown vaccination status	26 years male; no medical history; Gunshot wound to head	D-22: NPS + with CT= 31-34 D-1: NPS + with CT= 40; BAL –	Yes	2	48 years male with HCM; Status 3	No	2R, pAMR 1-I EF >55%	Negative	D+219, discharged home
6	Heart	No; Unknown vaccination status	24 years male; history of anxiety, depression and substance abuse; Drug overdose	D-2: NPS + with CT = 23	Yes	2	64 years male with ICM; Status 4	No	1R, pAMR 1-I EF >55%	N/A	D+216, discharged home
7	Heart	No; Unknown vaccination status	28 years male with history of substance abuse; Gunshot wound to neck	D-3: NPS +, CT=40.2, BAL – D-2: NPS –	Yes	2	66 years male with cardiac sarcoidosis; Status 4	No	1R, pAMR 0 EF >55%	N/A	D+215, discharged home
8e	Heart	No-mild symptoms; Unknown vaccination status	15 years female, no medical history; Pneumococcal meningitis	D-3: NPS+ D-2: NPS+ D-1: NPS +	Yes	2	53 years female with NICM; Status 6	No	1R, pAMR 0 EF >55%	N/A	D+205, discharged home
9	Lung	No-asymptomatic; Not vaccinated	18 years male with no medical history; Motor vehicle accident	D-38: NPS + D-3: NPS + with CT = 38.5; BAL— D-2: NPS – D 0: BAL—	N/A	2 Recipient also with history of COVID-19	56 years male with pulmonary fibrosis due to inhalational lung injury and prior COVID-19 Lung Allocation Score: 63.1859	No	No rejection	N/A	D+219, discharged home
10d	Heart	No- mild symptoms; Not vaccinated	25 years male, history of substance abuse, hepatitis C, history of Lyme disease; Cause of death unknown	D-12: NPS + D-4: NPS + D-2: NPS + D-1: BAL –	Yes	1; Recipient also with history of COVID-19	69 years male with NICM Status 2	No	1R, pAMR 0 EF >55%	N/A	D+92; index transplant hospitalization
11	Lung	No- asymptomatic; Unknown vaccination status	21 years male, no medical history Suicide	D-30: NPS +  D-4: NPS +, with CT = 34.4 D-3: BAL – D-3: NPS – D 0: BAL –	N/A	3	54 years male, with ILD Lung Allocation Score: 43.4458	No	No rejection	N/A	D+110; index transplantation
12	Heart	No; Unknown vaccination status	30y years male, no medical history; Drug overdose	D-3: NPS +, with CT = 28.1 D-2: BAL + with CT = 27.97	Yes	3	67 years male, history of ICM Status 2	No	1R, pAMR 0 EF 50%	N/A	D+90; index transplantation
13	Heart	No; Unknown vaccination status	23 years male, no medical history Drug overdose	D-4: NPS + with CT = 34.6 D-4: NPS (antigen) – D-3: NPS (antigen) – D-2: BAL –	Yes	2	51 years male, ICM Status 4	No	1R, pAMR 0 EF 50%	N/A	D+110; index transplantation

NPS +, nasopharyngeal swab PCR positive for COVID-19; NPS -, nasopharyngeal swab PCR negative for COVID-19; CT, cycle threshold; D, number of days prior to organ procurement; BAL, bronchoalveolar lavage; EF, ejection; HCM, hypertrophic cardiomyopathy; fraction; NICM, nonischemic cardiomyopathy; ICM, ischemic cardiomyopathy; pAMR, pathologic antibody mediated rejection; AV, aortic valve; VSD, ventricular septal defect; N/A, not applicable.

Median duration of follow up of recipients is 215 days (Q1: 110 days, Q3: 219 days).

^aDominant SARS-CoV-2 strains during this study period for subjects 1-10 were alpha and delta; for subjects 11-13 omicron.

^bGenomic targets and sensitivity of SARS-CoV-2 testing platforms vary. Organ procurement centers did not provide information on assays used for each donor, or did the centers provide sequencing information.

^cHeart function at procurement as assessed grossly and by echocardiogram was normal. All hearts had left ventricular EF >55%, normal right ventricular function and normal appearing valves.

^dGraft function: Patients underwent routine scheduled allograft biopsies according to schedule discussed in Supplement. The biopsy with the greatest level of rejection is included in this table.

^eCycle threshold values not provided by Organ Procurement Centers.