Transplantation of organs from SARS‐CoV‐2‐positive donors: Preliminary experience from Spain

Abstract

Background The utilization of non‐lung organs from deceased donors with a positive polymerase chain reaction (PCR) for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) at the time of donation can be lifesaving, although the safety of this policy must be assessed. Methods This is a nationwide, prospective study, reporting the experience on the utilization of non‐lung organs from SARS‐CoV‐2‐positive donors between December 15, 2020 and May 31, 2022 in Spain. Results A total of 69 patients received a solid organ transplant (41 kidney, 18 liver, 8 heart, and 2 combined liver–kidney) obtained from 32 donors with a positive SARS‐CoV‐2 PCR at the time of donation (four of them with a cycle threshold value <30). All recipients tested negative for SARS‐CoV‐2 and were free of coronavirus disease 2019 (COVID‐19) symptoms prior to transplantation. Nasopharyngeal swab turned positive for SARS‐CoV‐2 PCR in 4 (5.8%) recipients at 3, 8, 11, and 20 days after transplantation, though evidence did not support a donor‐derived COVID‐19. Four kidney recipients lost their grafts and two patients died: one heart recipient due to cardiogenic shock and one combined liver–kidney recipient due to lung hypertension and right heart failure. Graft losses and patient deaths were deemed unrelated to the donor SARS‐CoV‐2 status by the treating teams. No other adverse reactions were reported. Conclusions This preliminary experience supports the safety of the use of organs other than lungs from SARS‐CoV‐2 PCR‐positive donors, in alignment with previous series. However, the impact of SARS‐CoV‐2 infection upon organ quality should be established in future research.

Therapeutic strategy in the transplanted patient

“…However, it seems safe in the short term in terms of death and graft loss [ 26 ]. A preliminary Spanish experience supports the safety of the use of organs other than the lungs from SARS-CoV-2 PCR positive donors, in line with other previous series, establishing that if the cause of death was not COVID-19, the donation could be considered [ 27 ]. A recent systematic review showed that the use of organs, except the lung, from donors with SARS-CoV-2 infection appears to be a safe practice, with a low risk of transmission, regardless of the presence of symptoms at the time of collection.…”

Favorable experience of transplant strategy including liver grafts from COVID‐19 donors: One‐year follow‐up results

“…Some reports have come with evidence of acute arterial thrombosis in patients infected with SARS‐CoV2 34 and cases of post‐transplantation HAT after recovering from pre‐LT SARS‐CoV‐2 infection have been already published 35 . A Spanish experience 36 raised the concern as well that NAT+ donor organs could augment hypercoagulability and graft thrombosis through COVID‐related endothelial injury: from December 2020 to May 2022, 69 patients underwent transplant from NAT+ donors and two kidney recipients had graft loss due to renal vein thrombosis and hypoperfusion. Like Italy, Spain allows donation from mild COVID‐19 donors without a minimum time frame from symptom onset and procurement 12 .…”

Recommendations for SARS-CoV-2 testing and organ procurement from deceased donors in the Republic of Korea

“…Although the reported cases were limited in number, both the UK and Spain reported organ transplantations from donors who were positive for COVID-19 with no transmission to the recipients. Furthermore, the outcomes of the recipients were favorable [ 3 , 4 ] ( Table 2 ). Thus, although patients with COVID-19 are generally considered to be a risk for transmission through the respiratory route, it can be inferred that: (1) SARS-CoV-2 is not detected in nonlung organs, (2) transplantation of organs from donors who are positive for COVID does not result in the transmission of COVID-19, and (3) the short-term posttransplant outcomes for recipients appear not to be affected.…”

“…With a lack of research on the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) via organs in the early stages of the pandemic, it was recommended that transplantation of organs from deceased donors who tested positive for SARS-CoV-2 be avoided [ 2 ]. Subsequently, short-term observations showed the transmission of SARS-CoV-2 via organ transplantation in lung transplants only, accompanied by increasingly many reports of favorable outcomes in extrapulmonary organ transplantation from SARS-CoV-2-infected deceased donors [ 3 - 5 ]. Based on the guidelines of major transplant organizations, this study summarizes the available data for evaluating deceased donors for SARS-CoV-2 and the considerations for organ procurement from deceased donors with a history of COVID-19.…”