OPTN/SRTR 2022 Annual Data Report: COVID-19

Jonathan M. Miller^1,2, Yoon Son Ahn¹, Allyson Hart^1,2, Dorry L. Segev^1,3, David P. Schladt¹, Kathryn T. Livelli⁴, Kelsi A. Lindblad⁴, Ajay K. Israni^1,2,5, Jon J. Snyder^1,2,5

¹Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN

²Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN

³Department of Surgery, NYU Langone Health, New York, NY

⁴Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA

⁵Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN

Abstract

This chapter updates the COVID-19 chapter from the 2021 Annual Data Report with trends through November 12, 2022, and introduces trends in recovery and use of organs from donors with a positive COVID-19 test. Posttransplant mortality and graft failure, which remained a concern in all organs at the last report due to the Omicron variant wave, have returned to lower levels in the most recent available data through November 2022. Use of organs from donors with a positive COVID-19 test has grown, particularly after the first year of the pandemic. Mortality due to COVID-19 should continue to be monitored, but most other measures have sustained their recovery and may now be responding more to changes in policy than to ongoing concerns with COVID-19.

Keywords: COVID-19, solid organ transplant, transplant outcomes, waitlist mortality

1 Introduction

The COVID-19 pandemic has now continued for more than 3 years. While the most dramatic disruptions to transplant activity happened in the first months of the pandemic,¹^,²^,³^,⁴ the effects of COVID-19 on the US transplantation system are ongoing. This chapter updates the COVID-19 chapter from the OPTN/SRTR 2021 Annual Data Report⁵ with trends through November 12, 2022 (the most recently available complete data). SRTR continues to maintain an online app that is now updated quarterly and tracks these metrics, as well as more detailed subgroup and adjusted analyses, at https://www.srtr.org/tools/covid-19-evaluation.

The previous (2021) Annual Data Report presented monthly trends before and after the March 13, 2020, declaration of a national emergency through February 12, 2022. The previous report detailed the trends under the Delta variant (months 17 and 18 after the national emergency declaration: August 13, 2021, through October 12, 2021) and Omicron variant (months 21 and 22 after the national emergency declaration: December 13, 2021, through February 12, 2022). This current report describes trends after the subsidence of the Omicron variant wave, during the summer and fall months of 2022 when vaccines became available for every age group, including children younger than 5 years. This current report adds trends in use of organs from donors with a positive COVID-19 test that have not been reported previously.

2 Kidney

2.1 Waiting List

The number of prevalent kidney listings, which decreased by almost 5,000 in the first year of the pandemic, remained low. There were 104,647 candidates listed for kidney transplant in the month before the onset of the pandemic (February 13, 2021, through March 12, 2021), and there were 99,637 candidates listed for kidney transplant in the most recent month for which data are available (October 13, 2022, through November 12, 2022) (Figure COV 1). The numbers of new adult kidney candidates added to the waiting list each month for the most recent available year of data (November 13, 2021, through November 12, 2022) were similar (average 3,665 adult candidates added per month) to the numbers added each month in the 12 months before the pandemic (average 3,608 adult candidates added per month) (Figure COV 2).

Adult waitlist mortality rates, including active and inactive candidates, from March 13, 2022, through November 12, 2022, did not show any spike like those that correlated to the Delta variant wave and Omicron variant wave (Figure COV 8). However, average monthly adult waitlist mortality rates for the most recent year of available data are higher (6.8 deaths per 100 patient-years) than in the year prior to the pandemic (4.8 deaths per 100 patient-years). Monthly COVID-19–specific cause of death rates from March 13, 2022, through November 12, 2022, reached some of the lowest levels since the onset of the pandemic, dropping as low as 0.01 COVID-19 deaths per 100 patient-years (Figure COV 9). Following an increase in overall waitlist mortality rates for pediatric candidates during the Delta variant wave, pediatric waitlist mortality rates from March 13, 2022, through November 12, 2022, were not noticeably different from rates during the year prior to the pandemic (Figure COV 8).

Geographically, all regions of the US experienced higher kidney waitlist mortality from COVID-19 during waves of the pandemic. Notably, though, the Northeast US experienced a higher waitlist mortality rate during the first months of the pandemic than other regions, and the Southwest US experienced a higher waitlist mortality rate during the winter 2020-2021 wave of the pandemic than other regions (Figure COV 10).

2.2 Transplant Rates

Living donor transplant rates decreased from an average monthly rate of 6.5 transplants per 100 patient-years for adults (17.0 for pediatric) in the 12 months prior to the pandemic to 4.8 transplants per 100 patient-years for adults (14.4 for pediatric) in the 12 months following the onset of the pandemic. For the most recent year of data available (November 13, 2021, through November 12, 2022), average monthly transplant rates for adults (5.9 transplants per 100 patient-years) were only slightly lower than average rates in the 12 months prior to the pandemic (6.5 transplants per 100 patient-years), while transplant rates for pediatrics (13.7 transplants per 100 patient-years) remained lower than the 12 months prior to the pandemic (17.0 transplants per 100 patient-years) (Figure COV 4).

Deceased donor transplant rates for adult candidates, which did not decrease notably in the 12 months following the onset of the pandemic compared with the 12 months prior to the pandemic, were higher from November 13, 2021, through November 12, 2022 (average rate 20.3 transplants per 100 patient-years) than for the year prior to the pandemic (average rate 18.0 transplants per 100 patient-years), while average monthly pediatric transplant rates were slightly lower for the most recent year (36.1 transplants per 100 patient-years) than in the year prior to the pandemic (38.4 transplants per 100 patient-years) (Figure COV 3).

Geographically, while transplant rates in all US regions were lower in the first months of the pandemic than in the following months, after the first months of the pandemic, transplant rates rose in all regions and did not change notably through the following months (Figure COV 5).

2.3 Offers

The number of kidney offers made remained substantially higher compared with the year before the start of the pandemic (Figure COV 6) and the unadjusted offer acceptance rate remained substantially lower (Figure COV 7) in the most recent year of data. However, as noted in the previous (2021) Annual Data Report, these changes correspond with the implementation of the 250–nautical-mile circle kidney allocation policy on March 15, 2021, which replaced OPO DSA with a 250–nautical-mile circle around the donor hospital as the unit for local allocation.

2.4 Graft Failure

Adult all-cause kidney graft failure rates, among patients who underwent transplant in 2000 or later and were alive and at risk for graft failure in a given month, had peaks during the Delta and Omicron waves. However, from March 13, 2022, through November 12, 2022, these rates remained at or lower than levels from the year prior to the pandemic (Figure COV 11), with correspondingly low rates of COVID-19–specific posttransplant mortality, among patients who underwent transplant at any time and were alive and at risk for graft failure in a given month (Figure COV 12).

Geographically, all regions of the US experienced higher COVID-19–specific posttransplant mortality during waves of the pandemic. Notably, though, the Northeast US experienced a higher COVID-19–specific posttransplant mortality rate during the first months of the pandemic than other regions (Figure COV 13).

3 Pancreas

3.1 Waiting List

The number of prevalent pancreas candidates has continued a gradual increase that started before the pandemic (Figure COV 14). The number of new pancreas candidates added each month in the most recent year of data from November 13, 2021, through November 12, 2022 (monthly average 144 adult and 3 pediatric candidates) was similar to levels in the year before the start of the pandemic (monthly average 151 adult and 3 pediatric) (Figure COV 15). Mortality rates on the pancreas waiting list, including active and inactive candidates, remained similar in the most recent year of data (monthly average 5.5 adult deaths per 100 patient-years) compared with the year prior to the pandemic (monthly average 5.4 adult deaths per 100 patient-years) (Figure COV 18). Only one recorded COVID-19–specific cause of death has occurred among pancreas waitlist candidates, during month 22 after the national emergency declaration.

3.2 Transplant Rates

The pancreas deceased donor transplant rate remained lower in the most recent year of data (monthly average 36.7 adult transplants per 100 patient-years) than in the year before the pandemic (monthly average 44.7 adult transplants per 100 patient-years) (Figure COV 16). Geographically, there were no notable trends in pancreas transplant rates across US regions throughout the months of the pandemic (Figure COV 17).

3.3 Graft Failure

In the most recent year of data, adult pancreas all-cause graft failure, among patients who underwent transplant in 2000 or later and were alive and at risk for graft failure in a given month, was slightly higher (monthly average 6.2 graft failures per 100 patient-years) than in the year prior to the pandemic (monthly average 5.3 graft failures per 100 patient-years) (Figure COV 19). Following the peak in COVID-19–specific deaths among pancreas transplant recipients during the Omicron variant wave, COVID-19–specific deaths have remained at a relatively low rate through November 12, 2022 (Figure COV 20). While pancreas transplant volumes are lower and trends in posttransplant mortality should be interpreted cautiously, there seems to have been a higher posttransplant COVID-19–specific mortality rate in the Northwest US during the Delta variant wave (August 13, 2021 – October 12, 2021) (Figure COV 21).

4 Liver

4.1 Waiting List

An ongoing downward trend in prevalent adult liver listings continued from March 2022 through November 2022 (Figure COV 22). The monthly number of new listings in the most recent year of data from November 13, 2021, through November 12, 2022 (monthly average 1,062 new adult and 64 new pediatric listings) remained similar to levels in the year before the start of the pandemic (monthly average 1,075 new adult and 56 new pediatric listings) (Figure COV 23). Liver waitlist mortality, including active and inactive candidates, was no higher in the most recent year of data (monthly average 13.0 adult candidate deaths per 100 patient-years) than levels in the year before the pandemic (monthly average 13.7 adult candidate deaths per 100 patient-years) (Figure COV 29). Reported COVID-19–specific cause of death, which had shown peaks at previous waves of the pandemic, remained quite low from March 13, 2022, through November 12, 2022 (Figure COV 30). Geographically, all regions of the US experienced higher liver waitlist mortality from COVID-19 during waves of the pandemic. Notably, though, the Southwest US experienced a higher waitlist mortality rate during the winter 2020-2021 wave of the pandemic than other regions (Figure COV 31).

4.2 Transplant Rates

Deceased donor transplant rates (Figure COV 24) and living donor transplant rates (Figure COV 25) were higher in the most recent year of data (monthly average 76.2 adult deceased donor and 4.7 adult living donor transplants per 100 patient-years) as compared to the year prior to the start of the pandemic (monthly average 62.9 adult deceased donor and 3.6 adult living donor transplants per 100 patient-years). Numbers of liver offers in the most recent year of data (monthly average 24,426 liver offers to adult candidates) remained higher than levels in the year before the pandemic (monthly average 14,726 liver offers to adult candidates) (Figure COV 27), and unadjusted offer acceptance rates remained lower than levels before the pandemic (Figure COV 28); these trends are likely due to implementation of the liver acuity circle allocation policy in February 2020. Geographically, while liver transplant rates in all US regions were lower in the first months of the pandemic than in the following months, after the first months of the pandemic, transplant rates rose in all regions and did not change notably through the following months (Figure COV 26).

4.3 Graft Failure

Liver all-cause graft failure, among patients who underwent transplant in 2000 or later and were alive and at risk for graft failure in a given month, which reached a high point during the Omicron variant wave, returned to a lower level from March 13, 2022, through November 12, 2022 (Figure COV 32). The COVID-19–specific cause of death rate among liver recipients also reached its lowest levels, with monthly rates as low as 0.03 COVID-19 deaths per 100 patient-years, from March 13, 2022, through November 12, 2022 (Figure COV 33). Geographically, all regions of the US experienced higher COVID-19–specific posttransplant mortality during waves of the pandemic (Figure COV 34).

5 Intestine

Small numbers of patients receiving or waiting for an intestine transplant led to high month-to-month variability in metrics, making it difficult to detect any trends related to the pandemic (Figure COV 35, Figure COV 36, Figure COV 37, Figure COV 38, and Figure COV 39). The decrease in the number of prevalent pediatric candidates and increase in the number of prevalent adult candidates during the pandemic noted in the previous (2021) Annual Data Report continued from March 2022 through November 2022 (Figure COV 35).

6 Lung

6.1 Waiting List

The number of prevalent lung listings in the most recent year of data (monthly average 1,317 adult and 31 pediatric candidates) remained lower than in the year before the start of the pandemic (monthly average 1,700 adult and 42 pediatric candidates) (Figure COV 40). The number of new lung listings per month in the most recent year of data (monthly average 264 adult and 4 pediatric candidates) was similar to the year before the start of the pandemic (monthly average 270 adult and 6 pediatric candidates) (Figure COV 41). There was no noticeable trend in unadjusted offer acceptance rates (Figure COV 45).

Rates of overall lung waitlist mortality, including active and inactive candidates, have not been substantially higher after the start of the pandemic (Figure COV 46), and while there have been deaths due to COVID-19 among lung waitlist candidates, there have been very few COVID-19 deaths in lung candidates since March 13, 2022, following the Omicron variant wave (Figure COV 47). Geographically, most regions of the US experienced higher COVID-19–specific waitlist mortality during waves of the pandemic (Figure COV 48).

6.2 Transplant Rate

The lung transplant rate continued an upward trend in the most recent year of data compared with the year before the start of the pandemic (Figure COV 42). Offer numbers, which lowered notably following the start of the pandemic, returned to and surpassed levels seen in the year before the pandemic in the most recent months of data (Figure COV 44). Geographically, while lung transplant rates in most US regions were lower in the first months of the pandemic than in the following months, after the first months of the pandemic, transplant rates rose in all regions and did not change notably through the following months (Figure COV 43).

6.3 Graft Failure

Following peaks in both all-cause lung graft failure, among patients who underwent transplant in 2000 or later and were alive and at risk for graft failure in a given month, as well as COVID-19–specific cause of posttransplant deaths during the Omicron variant wave, all-cause lung graft failure and COVID-19–specific cause of posttransplant death returned to lower levels from March 13, 2022, through November 12, 2022 (Figure COV 49 and Figure COV 50). Geographically, all regions of the US experienced higher COVID-19–specific posttransplant mortality during waves of the pandemic (Figure COV 51).

7 Heart

7.1 Waiting List

The number of prevalent adult heart listings continued a downward trend that was already apparent in the year before the pandemic, while the prevalent pediatric heart listings continued on an upward trend (Figure COV 52), with a monthly average of 3,747 adult and 466 pediatric candidates waiting in the year before the start of the pandemic and 3,367 adult and 538 pediatric candidates in the most recent year of data (November 13, 2021, through November 12, 2022). The number of new heart listings per month was similar in the most recent year of data (monthly average 363 adult and 60 pediatric candidates) to in the year before the start of the pandemic (monthly average 341 and 58 pediatric candidates) (Figure COV 53). The number of adult heart offer numbers continued an upward trend in the most recent year of data and pediatric offers remained stable (monthly average 4,919 adult and 285 pediatric offers) compared with the year before the pandemic (monthly average 3,833 adult and 299 pediatric offers) (Figure COV 56), with unadjusted adult offer acceptance rates decreasing slightly (Figure COV 57). As with other organs, heart allocation policy was changed recently, with the January 2020 removal of DSA from heart allocation, making it difficult to attribute any changes in listings solely to COVID-19.

There have not been any additional reported heart waitlist COVID-19–specific deaths since the previous report (Figure COV 59), and rates of adult heart waitlist mortality, including active and inactive candidates, have not changed notably after the start of the pandemic; pediatric heart waitlist mortality has continued a downward trend (Figure COV 58). Geographically, most regions of the US experienced higher COVID-19–specific waitlist mortality during waves of the pandemic (Figure COV 60).

7.2 Transplant Rate

The adult heart transplant rate continued an upward trend in the most recent year of data (monthly average 118 transplant per 100 patient-years) compared with the year before the start of the pandemic (monthly average 92 transplants per 100 patient-years), although pediatric transplant rates continued a downward trend (monthly average 103 transplants per 100 patient-years in the most recent year of data; 122 transplants per 100 patient-years in the year before the pandemic) (Figure COV 54). Geographically, heart transplant rates showed notable trends during the months of the pandemic (Figure COV 55).

7.3 Graft Failure

Following high rates of graft failure reported in the months corresponding to the Omicron variant wave noted in the previous report, heart all-cause graft failure rates, among patients who underwent transplant in 2000 or later and were alive and at risk for graft failure in a given month, returned to lower levels from March 13, 2022, through November 12, 2022 (Figure COV 61), and COVID-19–specific cause of death decreased back to lower levels (Figure COV 62). Geographically, all regions of the US experienced higher COVID-19–specific posttransplant mortality during waves of the pandemic (Figure COV 63).

8 Deceased Donor

While organs from donors with a positive COVID-19 test were recovered for transplant as early as the month from May 13 to June 12, 2020, recovery of these organs remained low in the first year of the pandemic. Recovery from donors with a positive COVID-19 test began an upward trend for all organs, but remained low for pancreas and lung, in the second year of the pandemic and showed a distinct peak during the Omicron variant wave, reaching as high as 603 kidneys, 182 livers, and 54 hearts in a month during that wave (Figure COV 64). Nonuse percents were variable, but relatively high for kidneys and livers from donors with a positive COVID-19 test during the early months in which these organs were considered. By the third year of the pandemic, nonuse of organs from donors with a positive COVID-19 test had stabilized and was around 20%-25% for kidneys and 4%-8% for livers (Figure COV 65).

9 Discussion

The previous (2021) Annual Data Report noted that while transplant rates continued to remain at or even slightly above prepandemic levels, deaths due to COVID-19, both pretransplant and posttransplant, surged at waves of the pandemic.⁵ Encouragingly, since the previous report, COVID-19 deaths and overall waitlist mortality and posttransplant all-cause graft failure have returned, for most organs, to levels seen prior to waves of the pandemic. The waves of the pandemic did not hit all parts of the country at exactly the same time, yet limitations in incidence data mean that the scope of the Annual Data Report is restricted to analyzing COVID-19 mortality as reported to the OPTN at relatively large geographic levels.

While it is difficult to disentangle effects of the pandemic from effects related to changes in organ allocation policy, continuing trends in many organs in transplant rates and offer numbers might indicate that the changes in these aspects of the transplant system are continuing to be less influenced by the pandemic and more influenced by recent changes in policy.

Use of organs from donors with a positive COVID-19 test has become more common in the third year of the pandemic, and the nonuse rates for these organs have stabilized from the high rates in the first year of the pandemic.

References

Miller J, Wey A, Musgrave D, Ahn YS, Hart A, Kasiske BL, Hirose R, Israni AK, Snyder JJ. Mortality among solid organ waitlist candidates during COVID-19 in the United States. Am J Transplant. 2021;21(6):2262-2268. doi:10.1111/ajt.16550

Boyarsky BJ, Werbel WA, Durand CM, Avery RK, Jackson KR, Kernodle AB, Snyder J, Hirose R, Massie IM, Garonzik-Wang JM, Segev DL, Massie AB. Early national and center-level changes to kidney transplantation in the United States during the COVID-19 epidemic. Am J Transplant. 2020;20(11):3131-3139. doi:10.1111/ajt.16167

Cholankeril G, Podboy A, Alshuwaykh OS, Kim D, Kanwal F, Esquivel CO, Ahmed A. Early impact of COVID-19 on solid organ transplantation in the United States. Transplantation. 2020;104(11):2221-2224. doi:10.1097/TP.0000000000003391

Khairallah P, Aggarwal N, Awan AA, Vangala C, Airy M, Pan JS, Murthy BVR, Winkelmayer WC, Ramanathan V. The impact of COVID-19 on kidney transplantation and the kidney transplant recipient- one year into the pandemic. Transpl Int. 2021;34(4):612-621. doi:10.1111/tri.13840

Miller J, Ahn YS, Hart A, Lindblad K, Jett C, Fox C, Hirose R, Israni AK, Snyder JJ. OPTN/SRTR 2021 Annual Data Report: COVID-19. Am J Transplant. 2023;23(2 suppl 1):S475-S522. doi:10.1016/j.ajt.2023.02.011

Support, Copyright, and Citation Information

This publication was produced for the U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), by Hennepin Healthcare Research Institute (HHRI) and the United Network for Organ Sharing (UNOS) under contracts HHSH75R60220C00011 and HHSH250201900001C, respectively.

This publication lists nonfederal resources in order to provide additional information to consumers. The views and content in these resources have not been formally approved by HHS or HRSA. Neither HHS nor HRSA endorses the products or services of the listed resources.

The OPTN/SRTR 2022 Annual Data Report is not copyrighted. Readers are free to duplicate and use all or part of the information contained in this publication. Data are not copyrighted and may be used without permission if appropriate citation information is provided.

Pursuant to 42 U.S.C. 1320b-10, this publication may not be reproduced, reprinted, or redistributed for a fee without specific written authorization from HHS.

Suggested Citations:

Full citation: Organ Procurement and Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR). OPTN/SRTR 2022 Annual Data Report. U.S. Department of Health and Human Services, Health Resources and Services Administration; 2024. Accessed [insert date]. http://srtr.transplant.hrsa.gov/annual_reports/Default.aspx
Abbreviated full citation: OPTN/SRTR 2022 Annual Data Report. HHS/HRSA; 2024. Accessed [insert date]. http://srtr.transplant.hrsa.gov/annual_reports/Default.aspx
Chapter citation: [Authors]. OPTN/SRTR 2022 Annual Data Report: [chapter]. Accessed [insert date]. http://srtr.transplant.hrsa.gov/annual_reports/Default.aspx
Chapter citation for AJT e-supplement available at amjtransplant.org: [Authors]. OPTN/SRTR 2022 Annual Data Report: [chapter]. Am J Transplant. 2024;24([issue and suppl numbers]):[page range]. [doi]

Publications based on data in this report or supplied on request must include a citation and the following statement: The data and analyses reported in the OPTN/SRTR 2022 Annual Data Report have been supplied by the United Network for Organ Sharing and Hennepin Healthcare Research Institute under contract with HHS/HRSA. The authors alone are responsible for reporting and interpreting these data; the views expressed herein are those of the authors and not necessarily those of the U.S. government.

This report is available at https://srtr.transplant.hrsa.gov. Individual chapters may be downloaded.

List of Figures

Figure COV 1: Number of prevalent kidney candidates
Figure COV 2: Number of new kidney candidates
Figure COV 3: Deceased donor kidney transplant rate
Figure COV 4: Living donor kidney transplant rate
Figure COV 5: Kidney transplant rate by US geographic region
Figure COV 6: Number of kidney offers
Figure COV 7: Kidney offer acceptance rate
Figure COV 8: Kidney waitlist mortality rate
Figure COV 9: Kidney waitlist COVID-19 mortality rate
Figure COV 10: Kidney waitlist COVID-19 mortality rate by US geographic region
Figure COV 11: Kidney all-cause graft failure
Figure COV 12: Kidney posttransplant COVID-19 mortality rate
Figure COV 13: Kidney posttransplant COVID-19 mortality rate by US geographic region
Figure COV 14: Number of prevalent pancreas candidates
Figure COV 15: Number of new pancreas candidates
Figure COV 16: Deceased donor pancreas transplant rate
Figure COV 17: Pancreas transplant rate by US geographic region
Figure COV 18: Pancreas waitlist mortality rate
Figure COV 19: Pancreas all-cause graft failure
Figure COV 20: Pancreas posttransplant COVID-19 mortality rate
Figure COV 21: Pancreas posttransplant COVID-19 mortality rate by US geographic region
Figure COV 22: Number of prevalent liver candidates
Figure COV 23: Number of new liver candidates
Figure COV 24: Deceased donor liver transplant rate
Figure COV 25: Living donor liver transplant rate
Figure COV 26: Liver transplant rate by US geographic region
Figure COV 27: Number of liver offers
Figure COV 28: Liver offer acceptance rate
Figure COV 29: Liver waitlist mortality rate
Figure COV 30: Liver waitlist COVID-19 mortality rate
Figure COV 31: Liver waitlist COVID-19 mortality rate by US geographic region
Figure COV 32: Liver all-cause graft failure
Figure COV 33: Liver posttransplant COVID-19 mortality rate
Figure COV 34: Liver posttransplant COVID-19 mortality rate by US geographic region
Figure COV 35: Number of prevalent intestine candidates
Figure COV 36: Number of new intestine candidates
Figure COV 37: Deceased donor intestine transplant rate
Figure COV 38: Intestine waitlist mortality rate
Figure COV 39: Intestine all-cause graft failure
Figure COV 40: Number of prevalent lung candidates
Figure COV 41: Number of new lung candidates
Figure COV 42: Deceased donor lung transplant rate
Figure COV 43: Lung transplant rate by US geographic region
Figure COV 44: Number of lung offers
Figure COV 45: Lung offer acceptance rate
Figure COV 46: Lung waitlist mortality rate
Figure COV 47: Lung waitlist COVID-19 mortality rate
Figure COV 48: Lung waitlist COVID-19 mortality rate by US geographic region
Figure COV 49: Lung all-cause graft failure
Figure COV 50: Lung posttransplant COVID-19 mortality rate
Figure COV 51: Lung posttransplant COVID-19 mortality rate by US geographic region
Figure COV 52: Number of prevalent heart candidates
Figure COV 53: Number of new heart candidates
Figure COV 54: Deceased donor heart transplant rate
Figure COV 55: Heart transplant rate by US geographic region
Figure COV 56: Number of heart offers
Figure COV 57: Heart offer acceptance rate
Figure COV 58: Heart waitlist mortality rate
Figure COV 59: Heart waitlist COVID-19 mortality rate
Figure COV 60: Heart waitlist COVID-19 mortality rate by US geographic region
Figure COV 61: Heart all-cause graft failure
Figure COV 62: Heart posttransplant COVID-19 mortality rate
Figure COV 63: Heart posttransplant COVID-19 mortality rate by US geographic region
Figure COV 64: COVID-19-Positive Deceased Donor Organs Recovered for Transplant by Organ
Figure COV 65: Nonuse Percent by COVID-19-Positive Deceased Donor Organs

**Number of prevalent kidney candidates.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Candidates listed at multiple centers are counted once per listing. Includes active and inactive candidates on the list any time during the month.

Figure COV 1: Number of prevalent kidney candidates. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Candidates listed at multiple centers are counted once per listing. Includes active and inactive candidates on the list any time during the month.

**Number of new kidney candidates.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. A new candidate is one who first joined the list during the given month, without having been listed in a previous month.

Figure COV 2: Number of new kidney candidates. Month 0 begins March 13, 2020, the date of declaration of the national emergency. A new candidate is one who first joined the list during the given month, without having been listed in a previous month.

**Deceased donor kidney transplant rate.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given month. Individual listings are counted separately.

Figure COV 3: Deceased donor kidney transplant rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given month. Individual listings are counted separately.

**Living donor kidney transplant rate.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of living donor transplants per 100 patient-years of waiting time in a given month. Individual listings are counted separately.

Figure COV 4: Living donor kidney transplant rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of living donor transplants per 100 patient-years of waiting time in a given month. Individual listings are counted separately.

**Kidney transplant rate by US geographic region.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of transplants per 100 patient-years of waiting time in the given month. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Geographic regions are defined as: Northeast (OPTN Regions 1, 2, and 9); Southeast (OPTN Regions 3, 4, and 11); Midwest (OPTN Regions 7, 8, and 10); Northwest (OPTN Region 6); Southwest (OPTN Region 5).

Figure COV 5: Kidney transplant rate by US geographic region. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of transplants per 100 patient-years of waiting time in the given month. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Geographic regions are defined as: Northeast (OPTN Regions 1, 2, and 9); Southeast (OPTN Regions 3, 4, and 11); Midwest (OPTN Regions 7, 8, and 10); Northwest (OPTN Region 6); Southwest (OPTN Region 5).

Figure COV 6: Number of kidney offers. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

Figure COV 7: Kidney offer acceptance rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

**Kidney waitlist mortality rate.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given month. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure COV 8: Kidney waitlist mortality rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given month. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

**Kidney waitlist COVID-19 mortality rate.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure COV 9: Kidney waitlist COVID-19 mortality rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

**Kidney waitlist COVID-19 mortality rate by US geographic region.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given month. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Geographic regions are defined as: Northeast (OPTN Regions 1, 2, and 9); Southeast (OPTN Regions 3, 4, and 11); Midwest (OPTN Regions 7, 8, and 10); Northwest (OPTN Region 6); Southwest (OPTN Region 5).

Figure COV 10: Kidney waitlist COVID-19 mortality rate by US geographic region. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given month. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Geographic regions are defined as: Northeast (OPTN Regions 1, 2, and 9); Southeast (OPTN Regions 3, 4, and 11); Midwest (OPTN Regions 7, 8, and 10); Northwest (OPTN Region 6); Southwest (OPTN Region 5).

Figure COV 11: Kidney all-cause graft failure. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

Figure COV 12: Kidney posttransplant COVID-19 mortality rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

**Kidney posttransplant COVID-19 mortality rate by US geographic region.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Geographic regions are defined as: Northeast (OPTN Regions 1, 2, and 9); Southeast (OPTN Regions 3, 4, and 11); Midwest (OPTN Regions 7, 8, and 10); Northwest (OPTN Region 6); Southwest (OPTN Region 5).

Figure COV 13: Kidney posttransplant COVID-19 mortality rate by US geographic region. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Geographic regions are defined as: Northeast (OPTN Regions 1, 2, and 9); Southeast (OPTN Regions 3, 4, and 11); Midwest (OPTN Regions 7, 8, and 10); Northwest (OPTN Region 6); Southwest (OPTN Region 5).

**Number of prevalent pancreas candidates.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Candidates listed at multiple centers are counted once per listing. Includes active and inactive candidates on the list any time during the month.

Figure COV 14: Number of prevalent pancreas candidates. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Candidates listed at multiple centers are counted once per listing. Includes active and inactive candidates on the list any time during the month.

**Number of new pancreas candidates.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. A new candidate is one who first joined the list during the given month, without having been listed in a previous month.

Figure COV 15: Number of new pancreas candidates. Month 0 begins March 13, 2020, the date of declaration of the national emergency. A new candidate is one who first joined the list during the given month, without having been listed in a previous month.

**Deceased donor pancreas transplant rate.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given month. Individual listings are counted separately.

Figure COV 16: Deceased donor pancreas transplant rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given month. Individual listings are counted separately.

**Pancreas transplant rate by US geographic region.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of transplants per 100 patient-years of waiting time in the given month. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Geographic regions are defined as: Northeast (OPTN Regions 1, 2, and 9); Southeast (OPTN Regions 3, 4, and 11); Midwest (OPTN Regions 7, 8, and 10); Northwest (OPTN Region 6); Southwest (OPTN Region 5).

Figure COV 17: Pancreas transplant rate by US geographic region. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of transplants per 100 patient-years of waiting time in the given month. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Geographic regions are defined as: Northeast (OPTN Regions 1, 2, and 9); Southeast (OPTN Regions 3, 4, and 11); Midwest (OPTN Regions 7, 8, and 10); Northwest (OPTN Region 6); Southwest (OPTN Region 5).

**Pancreas waitlist mortality rate.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure COV 18: Pancreas waitlist mortality rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure COV 19: Pancreas all-cause graft failure. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

Figure COV 20: Pancreas posttransplant COVID-19 mortality rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

**Pancreas posttransplant COVID-19 mortality rate by US geographic region.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Geographic regions are defined as: Northeast (OPTN Regions 1, 2, and 9); Southeast (OPTN Regions 3, 4, and 11); Midwest (OPTN Regions 7, 8, and 10); Northwest (OPTN Region 6); Southwest (OPTN Region 5).

Figure COV 21: Pancreas posttransplant COVID-19 mortality rate by US geographic region. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Geographic regions are defined as: Northeast (OPTN Regions 1, 2, and 9); Southeast (OPTN Regions 3, 4, and 11); Midwest (OPTN Regions 7, 8, and 10); Northwest (OPTN Region 6); Southwest (OPTN Region 5).

**Number of prevalent liver candidates.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Candidates listed at multiple centers are counted once per listing. Includes active and inactive candidates on the list any time during the month.

Figure COV 22: Number of prevalent liver candidates. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Candidates listed at multiple centers are counted once per listing. Includes active and inactive candidates on the list any time during the month.

**Number of new liver candidates.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. A new candidate is one who first joined the list during the given month, without having been listed in a previous month.

Figure COV 23: Number of new liver candidates. Month 0 begins March 13, 2020, the date of declaration of the national emergency. A new candidate is one who first joined the list during the given month, without having been listed in a previous month.

**Deceased donor liver transplant rate.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given month. Individual listings are counted separately.

Figure COV 24: Deceased donor liver transplant rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given month. Individual listings are counted separately.

**Living donor liver transplant rate.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of living donor transplants per 100 patient-years of waiting time in a given month. Individual listings are counted separately.

Figure COV 25: Living donor liver transplant rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of living donor transplants per 100 patient-years of waiting time in a given month. Individual listings are counted separately.

**Liver transplant rate by US geographic region.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of transplants per 100 patient-years of waiting time in the given month. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Geographic regions are defined as: Northeast (OPTN Regions 1, 2, and 9); Southeast (OPTN Regions 3, 4, and 11); Midwest (OPTN Regions 7, 8, and 10); Northwest (OPTN Region 6); Southwest (OPTN Region 5).

Figure COV 26: Liver transplant rate by US geographic region. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of transplants per 100 patient-years of waiting time in the given month. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Geographic regions are defined as: Northeast (OPTN Regions 1, 2, and 9); Southeast (OPTN Regions 3, 4, and 11); Midwest (OPTN Regions 7, 8, and 10); Northwest (OPTN Region 6); Southwest (OPTN Region 5).

Figure COV 27: Number of liver offers. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

Figure COV 28: Liver offer acceptance rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

**Liver waitlist mortality rate.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure COV 29: Liver waitlist mortality rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

**Liver waitlist COVID-19 mortality rate.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure COV 30: Liver waitlist COVID-19 mortality rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

**Liver waitlist COVID-19 mortality rate by US geographic region.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given month. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Geographic regions are defined as: Northeast (OPTN Regions 1, 2, and 9); Southeast (OPTN Regions 3, 4, and 11); Midwest (OPTN Regions 7, 8, and 10); Northwest (OPTN Region 6); Southwest (OPTN Region 5).

Figure COV 31: Liver waitlist COVID-19 mortality rate by US geographic region. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given month. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Geographic regions are defined as: Northeast (OPTN Regions 1, 2, and 9); Southeast (OPTN Regions 3, 4, and 11); Midwest (OPTN Regions 7, 8, and 10); Northwest (OPTN Region 6); Southwest (OPTN Region 5).

Figure COV 32: Liver all-cause graft failure. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

Figure COV 33: Liver posttransplant COVID-19 mortality rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

**Liver posttransplant COVID-19 mortality rate by US geographic region.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Geographic regions are defined as: Northeast (OPTN Regions 1, 2, and 9); Southeast (OPTN Regions 3, 4, and 11); Midwest (OPTN Regions 7, 8, and 10); Northwest (OPTN Region 6); Southwest (OPTN Region 5).

Figure COV 34: Liver posttransplant COVID-19 mortality rate by US geographic region. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Geographic regions are defined as: Northeast (OPTN Regions 1, 2, and 9); Southeast (OPTN Regions 3, 4, and 11); Midwest (OPTN Regions 7, 8, and 10); Northwest (OPTN Region 6); Southwest (OPTN Region 5).

**Number of prevalent intestine candidates.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Candidates listed at multiple centers are counted once per listing. Includes active and inactive candidates on the list any time during the month.

Figure COV 35: Number of prevalent intestine candidates. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Candidates listed at multiple centers are counted once per listing. Includes active and inactive candidates on the list any time during the month.

**Number of new intestine candidates.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. A new candidate is one who first joined the list during the given month, without having been listed in a previous month.

Figure COV 36: Number of new intestine candidates. Month 0 begins March 13, 2020, the date of declaration of the national emergency. A new candidate is one who first joined the list during the given month, without having been listed in a previous month.

**Deceased donor intestine transplant rate.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given month. Individual listings are counted separately.

Figure COV 37: Deceased donor intestine transplant rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given month. Individual listings are counted separately.

**Intestine waitlist mortality rate.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure COV 38: Intestine waitlist mortality rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure COV 39: Intestine all-cause graft failure. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

**Number of prevalent lung candidates.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Candidates listed at multiple centers are counted once per listing. Includes active and inactive candidates on the list any time during the month.

Figure COV 40: Number of prevalent lung candidates. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Candidates listed at multiple centers are counted once per listing. Includes active and inactive candidates on the list any time during the month.

**Number of new lung candidates.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. A new candidate is one who first joined the list during the given month, without having been listed in a previous month.

Figure COV 41: Number of new lung candidates. Month 0 begins March 13, 2020, the date of declaration of the national emergency. A new candidate is one who first joined the list during the given month, without having been listed in a previous month.

**Deceased donor lung transplant rate.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given month. Individual listings are counted separately.

Figure COV 42: Deceased donor lung transplant rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given month. Individual listings are counted separately.

**Lung transplant rate by US geographic region.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of transplants per 100 patient-years of waiting time in the given month. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Geographic regions are defined as: Northeast (OPTN Regions 1, 2, and 9); Southeast (OPTN Regions 3, 4, and 11); Midwest (OPTN Regions 7, 8, and 10); Northwest (OPTN Region 6); Southwest (OPTN Region 5).

Figure COV 43: Lung transplant rate by US geographic region. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of transplants per 100 patient-years of waiting time in the given month. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Geographic regions are defined as: Northeast (OPTN Regions 1, 2, and 9); Southeast (OPTN Regions 3, 4, and 11); Midwest (OPTN Regions 7, 8, and 10); Northwest (OPTN Region 6); Southwest (OPTN Region 5).

Figure COV 44: Number of lung offers. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

Figure COV 45: Lung offer acceptance rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

**Lung waitlist mortality rate.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure COV 46: Lung waitlist mortality rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

**Lung waitlist COVID-19 mortality rate.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure COV 47: Lung waitlist COVID-19 mortality rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

**Lung waitlist COVID-19 mortality rate by US geographic region.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given month. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Geographic regions are defined as: Northeast (OPTN Regions 1, 2, and 9); Southeast (OPTN Regions 3, 4, and 11); Midwest (OPTN Regions 7, 8, and 10); Northwest (OPTN Region 6); Southwest (OPTN Region 5).

Figure COV 48: Lung waitlist COVID-19 mortality rate by US geographic region. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given month. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Geographic regions are defined as: Northeast (OPTN Regions 1, 2, and 9); Southeast (OPTN Regions 3, 4, and 11); Midwest (OPTN Regions 7, 8, and 10); Northwest (OPTN Region 6); Southwest (OPTN Region 5).

Figure COV 49: Lung all-cause graft failure. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

Figure COV 50: Lung posttransplant COVID-19 mortality rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

**Lung posttransplant COVID-19 mortality rate by US geographic region.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Geographic regions are defined as: Northeast (OPTN Regions 1, 2, and 9); Southeast (OPTN Regions 3, 4, and 11); Midwest (OPTN Regions 7, 8, and 10); Northwest (OPTN Region 6); Southwest (OPTN Region 5).

Figure COV 51: Lung posttransplant COVID-19 mortality rate by US geographic region. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Geographic regions are defined as: Northeast (OPTN Regions 1, 2, and 9); Southeast (OPTN Regions 3, 4, and 11); Midwest (OPTN Regions 7, 8, and 10); Northwest (OPTN Region 6); Southwest (OPTN Region 5).

**Number of prevalent heart candidates.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Candidates listed at multiple centers are counted once per listing. Includes active and inactive candidates on the list any time during the month.

Figure COV 52: Number of prevalent heart candidates. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Candidates listed at multiple centers are counted once per listing. Includes active and inactive candidates on the list any time during the month.

**Number of new heart candidates.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. A new candidate is one who first joined the list during the given month, without having been listed in a previous month.

Figure COV 53: Number of new heart candidates. Month 0 begins March 13, 2020, the date of declaration of the national emergency. A new candidate is one who first joined the list during the given month, without having been listed in a previous month.

**Deceased donor heart transplant rate.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given month. Individual listings are counted separately.

Figure COV 54: Deceased donor heart transplant rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given month. Individual listings are counted separately.

**Heart transplant rate by US geographic region.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of transplants per 100 patient-years of waiting time in the given month. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Geographic regions are defined as: Northeast (OPTN Regions 1, 2, and 9); Southeast (OPTN Regions 3, 4, and 11); Midwest (OPTN Regions 7, 8, and 10); Northwest (OPTN Region 6); Southwest (OPTN Region 5).

Figure COV 55: Heart transplant rate by US geographic region. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Transplant rates are computed as the number of transplants per 100 patient-years of waiting time in the given month. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Geographic regions are defined as: Northeast (OPTN Regions 1, 2, and 9); Southeast (OPTN Regions 3, 4, and 11); Midwest (OPTN Regions 7, 8, and 10); Northwest (OPTN Region 6); Southwest (OPTN Region 5).

Figure COV 56: Number of heart offers. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

Figure COV 57: Heart offer acceptance rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

**Heart waitlist mortality rate.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure COV 58: Heart waitlist mortality rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

**Heart waitlist COVID-19 mortality rate.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure COV 59: Heart waitlist COVID-19 mortality rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

**Heart waitlist COVID-19 mortality rate by US geographic region.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given month. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Geographic regions are defined as: Northeast (OPTN Regions 1, 2, and 9); Southeast (OPTN Regions 3, 4, and 11); Midwest (OPTN Regions 7, 8, and 10); Northwest (OPTN Region 6); Southwest (OPTN Region 5).

Figure COV 60: Heart waitlist COVID-19 mortality rate by US geographic region. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given month. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Geographic regions are defined as: Northeast (OPTN Regions 1, 2, and 9); Southeast (OPTN Regions 3, 4, and 11); Midwest (OPTN Regions 7, 8, and 10); Northwest (OPTN Region 6); Southwest (OPTN Region 5).

Figure COV 61: Heart all-cause graft failure. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

Figure COV 62: Heart posttransplant COVID-19 mortality rate. Month 0 begins March 13, 2020, the date of declaration of the national emergency.

**Heart posttransplant COVID-19 mortality rate by US geographic region.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Geographic regions are defined as: Northeast (OPTN Regions 1, 2, and 9); Southeast (OPTN Regions 3, 4, and 11); Midwest (OPTN Regions 7, 8, and 10); Northwest (OPTN Region 6); Southwest (OPTN Region 5).

Figure COV 63: Heart posttransplant COVID-19 mortality rate by US geographic region. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Geographic regions are defined as: Northeast (OPTN Regions 1, 2, and 9); Southeast (OPTN Regions 3, 4, and 11); Midwest (OPTN Regions 7, 8, and 10); Northwest (OPTN Region 6); Southwest (OPTN Region 5).

**COVID-19-Positive Deceased Donor Organs Recovered for Transplant by Organ.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Organs included are organs recovered for transplant from donors who tested positive for COVID-19, whether or not the organ was eventually transplanted.

Figure COV 64: COVID-19-Positive Deceased Donor Organs Recovered for Transplant by Organ. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Organs included are organs recovered for transplant from donors who tested positive for COVID-19, whether or not the organ was eventually transplanted.

**Nonuse Percent by COVID-19-Positive Deceased Donor Organs.** Month 0 begins March 13, 2020, the date of declaration of the national emergency. Nonuse is the percent of organs 'recovered for transplant but not transplanted' out of the total number of COVID-19-positive organs recovered for transplant.

Figure COV 65: Nonuse Percent by COVID-19-Positive Deceased Donor Organs. Month 0 begins March 13, 2020, the date of declaration of the national emergency. Nonuse is the percent of organs ‘recovered for transplant but not transplanted’ out of the total number of COVID-19-positive organs recovered for transplant.