Organ transplantation using COVID-19-positive deceased donors

Abstract

The COVID‐19 pandemic has influenced organ transplantation decision making. Opinions regarding the utilization of coronavirus disease‐2019 (COVID‐19) donors are mixed. We hypothesize that COVID‐19 infection of deceased solid organ transplant donors does not affect recipient survival. All deceased solid organ transplant donors with COVID‐19 testing results from March 15, 2020 to September 30, 2021 were identified in the OPTN database. Donors were matched to recipients and stratified by the COVID‐19 test result. Outcomes were assessed between groups. COVID‐19 test results were available for 17 694 donors; 150 were positive. A total of 269 organs were transplanted from these donors, including 187 kidneys, 57 livers, 18 hearts, 5 kidney‐pancreases, and 2 lungs. The median time from COVID‐19 testing to organ recovery was 4 days for positive and 3 days for negative donors. Of these, there were 8 graft failures (3.0%) and 5 deaths (1.9%). Survival of patients receiving grafts from COVID‐19‐positive donors is equivalent to those receiving grafts from COVID‐19‐negative donors (30‐day patient survival = 99.2% COVID‐19 positive; 98.6% COVID‐19 negative). Solid organ transplantation using deceased donors with positive COVID‐19 results does not negatively affect early patient survival, though little information regarding donor COVID‐19 organ involvement is known. While transplantation is feasible, more information regarding COVID‐19‐positive donor selection is needed.

Real-time transcription polymerase chain reaction cycle threshold values as criteria for utilization of incidental COVID-19 positive lung donors

“…The emergence of the COVID-19 pandemic placed significant strain on solid organ transplantation. 1 , 2 As a consequence of the pandemic in 2020, there was a decline in both the number of lung transplants (LTs) performed as well as the number of recovered lung donors. 1 A potential explanation is related to the safety of utilizing of COVID-19 positive donors due to the risk of transmission of COVID-19 infection.…”

“… 3 Outcomes have been reported in other solid organs, yet there remains paucity of LTs described. 2 , 4 …”

COVID-19 in donation and transplant

“…The median time from COVID-19 testing to donation was 4 days for positive donors. Survival of patients who received grafts from COVID-19-positive donors and complications of graft dysfunction were equivalent to those who received grafts from COVID-19-negative donors [ 52 ]. Similar results were reported by Dhand et al with 193 COVID+ donors resulting in the transplantation of 281 kidneys, 106 livers and 36 hearts in 414 adult recipients [ 53 ].…”

Recent Advances and Outcomes in Heart and Lung Transplantation

“…While it was initially viewed apprehensively, studies were conducted to assess the impact of transplanting organs from COVID-19-infected donors to healthy recipients. Although statistics did not disclose any impact on the early survival rates, more long-term studies are necessary [3]. Recently, Eichenberger et al reported the safe and effective use of hearts from COVID-19-positive donors.…”