A pediatric patient with Alagille syndrome (ALGS) underwent a successful liver transplantation from a deceased asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA-positive pediatric donor without evidence of viral transmission.

In addition to this patient, 6 other patients with different diagnoses received organs from the same donor or a second pediatric donor who also tested positive for SARS-CoV-2.

“Based on the lack of transmission of SARS-CoV-2 to recipients of non-lung organs from asymptomatic adult donors, and the pediatric organ donation cases reported here, pediatric donors with non-disseminated SARS-CoV-2 infection should be considered as potential non-lung organ donors,” the authors said. The complete case report can be read in Pediatric Transplantation.

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The 2-year-old male patient with ALGS was alive at 5 months post-transplant and showed excellent graft function. He did not receive any post-transplant antiviral therapy, and he was discharged from the hospital 11 days after clinical admission.

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The donor was a previously healthy 16-month-old child who presented with severe anoxic brain injury and multiorgan system dysfunction. On clinical admission, the patient showed no evidence of acute respiratory or viral symptoms, and a routine admission screening SARS-CoV-2 polymerase chain reaction (PCR) nasopharyngeal test returned negative. The patient was declared deceased 4 days after the initial brain injury according to neurologic criteria.

Routine organ donation surveillance for infections confirmed negativity for SARS-CoV-2 infection on all tests performed prior to organ recovery, and the donor’s heart, liver, and en bloc kidneys were transplanted into 3 recipients. One day after donation and transplant, routine testing conducted at autopsy returned 3 positive SARS-CoV-2 PCR tests.

The other 2 recipients from this donor were diagnosed with tricuspid atresia with heart failure and renal sclerosis, unspecified, respectively. Recipients from the second donor were diagnosed with anthracycline-induced cardiomyopathy, primary biliary cholangitis, and polycystic kidney disease (n=2).


Clark JD, Albers EL, Albert JE, et al. SARS-CoV-2 RNA positive pediatric organ donors: a case report. Pediatr Transplant. Published online December 14, 2022. doi:10.1111/petr.14452