Utility of ABO genotyping for resolving serologic ambiguities in deceased organ donation

We evaluated blood group typing in a cohort of deceased organ donors comparing serological and genotyping methodologies. Our objectives were to determine the frequency and characteristics of serological discrepancies, assess concordance between phenotypic and genotypic results, and determine the utility of genotyping in resolving typing challenges in both the pre- and post-transfusion settings. Specimens from over forty-four thousand deceased donors were collected by Organ Procurement Organizations and submitted for STAT testing. Gel column agglutination or test tube method was performed for serological typing. Genotyping was performed on 471 donors using real-time PCR. Serologic ABO typing results were indeterminate in 4% of samples. ABO genotyping demonstrated high concordance with serologic typing in evaluable cases and successfully resolved many otherwise indeterminate donor evaluations. ABO genotyping is a reliable adjunct to serologic testing in deceased donor evaluation and provides value in transfused donors and cases with serologic ambiguity. Integration of genotyping methods into donor testing workflows may improve the safety, accuracy, and efficiency of organ allocation practices.