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Background The outcomes following COVID‐19 positive donor (CPD) utilization for heart transplant are unknown. Methods UNOS database was analyzed for heart transplants performed from the declaration of COVID‐19 pandemic until September 30, 2022. Result Since the onset of pandemic, there were 9876 heart transplants reported. COVID‐19 antigen or NAT results were available in 7698 adult donors within 14 days of donation, of which 177 (2.3%) were positive. There was no difference in recipient demographics, including age (COVID positive donor vs. negative: 55 vs. 56 years, p = .2) and BMI. Listing status 1 and 2 were similar in both groups (7% vs. 10% and 48% vs. 49% respectively, p = .4). Durable and temporary mechanical support were similar in both groups pre‐transplant (both groups 33%, p = .9). There was no difference in days on the waitlist (median 31 days, p = .9). Simultaneous renal transplant rates were similar (11% vs. 10%, p = .9). CPD utilization has increased since the onset of the pandemic, and the adoption is present across most UNOS regions. Post‐transplant, there was no difference in length of stay (median 16 vs. 17 days, p = .9) and acute rejection episodes prior to discharge (3% vs. 8%, p = .1). In survival analysis of 90‐day follow up, number of deaths reported were comparable (5% in both groups, p = .9) Follow‐up LVEF was comparable (62% vs. 60%, p = .4). Conclusion Active COVID‐19 infection in donors did not affect survival or rejection rates in the short‐term post‐heart transplant.

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