Related Experiment Video
Updated: Aug 6, 2025
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Heart Transplantation from COVID-19-Positive Donors: A Word of Caution
Alejandra Castro-Varela1, Carlos Gallego-Navarro1, Eric Bhaimia2
1Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
Insights
Heart transplants using donors positive for SARS-CoV-2 are feasible. With careful screening and postexposure prophylaxis, recipients show good outcomes, with no post-transplant COVID-19 infections observed.
Area of Science:
- Cardiology
- Transplantation Medicine
- Infectious Diseases
Background:
- Maintaining solid-organ transplantation during the COVID-19 pandemic presented challenges.
- The use of donors positive for SARS-CoV-2 (the virus causing COVID-19) was explored to expand the donor pool.
Purpose of the Study:
- To evaluate the initial experience and safety of heart transplantation using donors positive for SARS-CoV-2.
- To assess outcomes and complications in recipients of hearts from SARS-CoV-2-positive donors.
Main Methods:
- Six heart transplantations were performed using donors who tested positive for SARS-CoV-2.
- Donors underwent rigorous screening, including negative bronchoalveolar lavage PCR.
- Recipients received postexposure prophylaxis, including anti-spike monoclonal antibodies and/or remdesivir.
Main Results:
- Five out of six patients experienced successful outcomes and were discharged.
- One transplant was complicated by graft dysfunction requiring extracorporeal membrane oxygenation and retransplantation.
- No recipients developed COVID-19 infection post-transplant.
Conclusions:
- Heart transplantation from SARS-CoV-2-positive donors is a viable option.
- Adequate donor screening and recipient postexposure prophylaxis are crucial for safety and success.
- This approach can help sustain heart transplant programs during viral pandemics.
Background:
During the COVID-19 pandemic, efforts to maintain solid-organ transplantation have continued, including the use of SARS-CoV-2-positive heart donors.
Methods:
We present our institution's initial experience with SARS-CoV-2-positive heart donors. All donors met our institution's Transplant Center criteria, including a negative bronchoalveolar lavage polymerase chain reaction result. All but 1 patient received postexposure prophylaxis with anti-spike monoclonal antibody therapy, remdesivir, or both.
Results:
A total of 6 patients received a heart transplant from a SARS-CoV-2-positive donor. One heart transplant was complicated by catastrophic secondary graft dysfunction requiring venoarterial extracorporeal membrane oxygenation and retransplant. The remaining 5 patients did well postoperatively and were discharged from the hospital. None of the patients had evidence of COVID-19 infection after surgery.
Conclusion:
Heart transplants from SARS-CoV-2 polymerase chain reaction-positive donors are feasible and safe with adequate screening and postexposure prophylaxis.
