HomeDonated organ from dying COVID-19 patients is safe for transplant recipients

Donated organ from dying COVID-19 patients is safe for transplant recipients

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Donors who have been diagnosed with SARS-CoV-2 before donating their organs appear safe and do not transmit COVID-19 to the recipient, says a new study.

Organ donation from dying donors who tested positive for SARS-CoV-2 appears to be safe and does not result in the transmission of COVID-19 to the recipient, according to new research led by Dr. Cameron Wolfe and Dr. Emily Eichenberger and colleagues, from Duke University School of Medicine.

Due to the unknown dangers of using organs from COVID-19 infected donors, the COVID-19 pandemic has compounded the shortage of abdominal organs for donation by raising organ discard rates. COVID-19-infected donors may be able to help alleviate the consequences of the current outbreak on discarded organs and the overall organ shortage by donating their organs. However, little is known about the best approaches for donor selection and recipient treatment.

As not all organs from COVID-19 positive donors are suitable for transplantation, donors were evaluated in this preliminary study based on the organ type, the duration and severity of COVID-19 illness, the presence of signs of hypercoagulable disease (meaning possible increased clotting in the donated organ or vessels), and a thorough overall inspection at the time of organ procurement. When assessing the risk, the urgency of the transplant for the recipient was also considered.

If the organ to be donated was the lung or intestine, for example, it would only be considered if the donor had last tested positive for COVID-19 more than 20 days ago, which is consistent with the US Centers for Disease Control and Prevention’s infection control practices (CDC). If the virus was detected in the base of the lungs, the lungs were ruled unfit for transplant, but other organs might be safely transferred if the donor was not dying from severe hyperinflammatory COVID-19 or exhibited evidence of excessive clotting. Even after overcoming all of these obstacles, clinicians must analyze the donor’s eventual cause of death and assess if this will have a detrimental influence on organ quality and/or surgical risk.

To further reduce transplant risk, recipients are now highly encouraged to be fully COVID-19 vaccinated prior to surgery, despite the fact that not all recipients in this preliminary trial had had that opportunity, and all four organ recipients in this study were unvaccinated.

As explained by Dr. Eichenberger: “Being unvaccinated can increase the risk for of severe COVID-19 in transplanted patients due to their immunosuppression drugs post-transplant. For that reason, we strongly encourage our patients on the waiting list to get vaccinated. However, being unvaccinated does not take someone off the organ transplant waiting list at our institution at this time.”

While a vaccinated donor is preferable because it minimizes the risk of severe organ inflammation, organs from COVID-19 infected donors with unclear or negative donor vaccine status could still be used.

The team describes the first six abdominal organ transplantations conducted utilizing the protocol (2 livers, 2 kidneys/pancreas implanted simultaneously) in four recipients using organs obtained from four donors who tested positive for COVID-19 on nose-throat and/or lung tests. All four donors were subjected to a macroscopic and/or microscopic biopsy assessment to establish organ compatibility as part of the protocol-driven donor evaluation. The characteristics of the donor and receiver can be found in the link below.

During their terminal illness, all of the donors tested positive for SARS-CoV-2. One donor died of pulmonary emboli (lung clots) caused by severe COVID-19 infection, while another died of a polymicrobial brain abscess likely prompted by antecedent COVID-19. The other two had COVID-19 disease that was mild to moderate and died from other reasons (one a stroke caused by a brain bleed, the other of a drug overdose).

With a median recipient follow-up of 46 days, all 6 abdominal organs maintained sustained transplant function. There was no surprising rejection. There were no COVID-19 infections among transplant patients, and there were no COVID-19 transmissions among healthcare workers. Due to unrelated surgical difficulties including a blockage in a coronary artery (coronary thrombus) in the transplanted heart, one heart-liver recipient underwent a second heart transplant. Using a heart from another COVID-19 positive donor, an urgent heart re-transplantation was successfully done (who was asymptomatic and died from a gunshot wound).

Dr. Eichenberger added: “While limited, our experience to date supports the use of abdominal organs from COVID-19 positive donors as safe and effective, even those actively infected, or with lung disease caused by COVID-19.”

While this first study only includes the first six patients, she notes that the Duke team has now completed 20 abdominal organ transplants utilizing the protocol, with the outcomes serving as the foundation for future abstracts and research papers.

According to her: “Reassuringly, no recipients or surgical / procurement team members have contracted COVID-19 as a result of this protocol, and the outcomes for the recipients appear consistent with expected transplant outcomes.  The protocol has remained unchanged.”

Evidence for donated organs from donors with a history of COVID-19 is still in its infancy, as it is at other transplant centers across the world, and more research from various centers around the world are needed to corroborate these apparently promising results.

Source: European Congress of Clinical Microbiology & Infectious Diseases (ECCMID 2022, Lisbon, 23-26 April)

Image Credit: Getty

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