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Transplanting thoracic COVID-19 positive donors: An institutional protocol and report of the first 14 cases
Emily M Eichenberger1, Amanda C Coniglio2, Carmelo Milano3
1Division of Transplant Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
Insights
This study shows that thoracic organ transplants from donors positive for COVID-19 can be safe and effective, with high patient and graft survival rates. Careful donor selection is key for successful heart and lung transplants.
Area of Science:
- Transplantation Medicine
- Infectious Diseases
- Cardiology
Background:
- The COVID-19 pandemic created challenges for organ donation due to donor positivity.
- Donor selection criteria for COVID-19 positive donors were not well-established.
Purpose of the Study:
- To present a protocol for evaluating and transplanting thoracic organs from donors positive for COVID-19.
- To report outcomes of these transplants.
Main Methods:
- Developed specific eligibility criteria for heart and lung donors based on COVID-19 status and clinical presentation.
- Performed 14 thoracic transplants (heart and lung) using organs from selected COVID-19 positive donors.
- Monitored recipients and healthcare workers for SARS-CoV-2 infection and acute rejection.
Main Results:
- No recipients or healthcare workers acquired COVID-19 post-transplant.
- No recipients experienced unexpected acute rejection.
- Achieved 92% patient survival and 93% graft survival at the follow-up period.
Conclusions:
- Transplanting hearts from carefully selected COVID-19 positive donors appears safe and effective.
- Lung transplantation from COVID-19 positive donors warrants cautious consideration under strict criteria.
- This protocol offers a potential strategy to expand the donor pool.
Abstract:
We present our institution's protocol for evaluating and transplanting thoracic organs from COVID-19 positive donors and report the outcomes to date. Hearts from donors testing positive for COVID-19 on any test were eligible for transplantation at our institution provided the donor exhibited no evidence of hypercoagulability or COVID-19 induced hyperinflammatory state during terminal hospitalization. Lungs were eligible if the donor first tested PCR positive on nasopharyngeal swab (NPS) for COVID-19 > 20 days prior to procurement and had a negative lower respiratory tract specimen. We performed 14 thoracic transplants in 13 recipients using organs from COVID-19 positive donors. None of the recipients or healthcare members acquired COVID-19. No recipients suffered unexpected acute rejection. Patient survival is 92% to date, with graft survival 93%. The use of hearts from COVID-19 positive donors may be safe and effective. Transplantation of lungs is unresolved but may be cautiously pursued under the restricted circumstances.
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