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Covid-19 positive donor utilization for heart transplantation: The new frontier for donor pool expansion
Gaurang Nandkishor Vaidya1, Paul Anaya1, Maya Ignaszewski1
1Department of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky, USA.
Insights
Hearts from COVID-19 positive donors (CPD) are increasingly used in transplants despite limited evidence. Standardized guidelines could expand the donor pool, addressing a critical need in heart transplantation.
Area of Science:
- Cardiology
- Transplantation Immunology
- Infectious Disease Epidemiology
Background:
- Hearts from COVID-19 positive donors (CPD) are utilized in transplantation without established guidelines or robust evidence.
- The Organ Procurement and Transplantation Network (OPTN) classifies CPD utilization as an "unknown risk" due to this evidence gap.
Discussion:
- Analysis of the UNOS database (Jan 2021-Dec 2022) revealed significant utilization of CPDs in adult heart transplants.
- CPDs represented over 10% of donors in some regions, with 7.9% of transplants using CPDs between July-December 2022.
- This utilization rate rivals that of Hepatitis C positive donors (7.1%) and donation after circulatory death (DCD) donors (10.3%) during the same period.
Key Insights:
- CPD hearts are a growing, albeit unproven, resource in heart transplantation.
- The current use of CPDs highlights a critical need for evidence-based protocols.
- Standardized approaches are essential to safely integrate CPDs into donor pool expansion strategies.
Outlook:
- Developing standardized protocols for CPD utilization can significantly expand the donor pool for heart transplantation.
- Further research is needed to establish safety and efficacy, potentially leading to formal OPTN guidelines.
- This strategy could mitigate donor shortages and improve access to life-saving heart transplants.
Background:
Hearts from COVID-19 positive donors (CPD) are being utilized for heart transplantation by some centers; however, this is in the setting of the lack of guidelines or robust evidence. The paucity of evidence is reflected in the recent Organ Procurement and Transplantation Network (OPTN) communication describing CPD utilization as an "unknown risk."
Methods And Results:
We analyzed the UNOS database for adult heart transplants performed between January 2021 to December 2022, and CPD comprised of a significant percentage of donors, being used in >10% of recipients in some UNOS regions. Between July 2022 and December 2022, 7.9% of heart transplants were with CPD, and in the same period Hepatitis C positive donors accounted for 7.1% and donation after circulatory death (DCD) accounted for 10.3%.
Conclusion:
If the transplant community comes up with a standardized approach and guidance in using CPD hearts, this could provide an effective donor pool expansion strategy.
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