The coronavirus disease 2019 drastically impacted solid organ transplantation. Lacking scientific evidence, very stringent but presumably safer policies were imposed on organs donation and solid organ transplantation in the early stages of the pandemic. A priori policies and practices required a negative SARS-Cov-2 real-time polymerase chain reaction (PCR) of donors and recipients. Unfortunately, prolonged viral RNA shedding in candidates recovering from SARS-CoV-2 frequently hinders donation and transplantation. These a priori restrictive donation and transplant guidelines must be reevaluated and adjusted according to accumulating medical knowledge and detrimental consequences of stringency. Recent data reveal the devastating impact of stringency on waitlist time, disease progression, drop-out, and mortality. Moreover, positive PCR test results for viral genome are frequently due to non-infectious and prolonged convalescent shedding of viral genome and the cycle threshold of quantitative PCR could be leveraged to inform clinical transplant decision-making. In late 2020 we presented an evidence-adjusted significantly less restrictive policy for LT, where risk tolerance is tiered to recipient acuity. This review summarizes the evolution of policies and practices for organ recovery and transplantation in candidates recovering from COVID-2019, since then. Leniency was, subsequently, introduced into several societal and governmental recommendations for organ donation and transplantation. However, serious analytical considerations limit the use of cycle threshold to local institutional algorithms.

SARS-CoV-2, Solid organs transplant, Polymerase chain reaction, Cycle threshold, Non-infectious shedding, Organ donation, Guidelines