Organs From Donors With COVID-19 May Be Transplanted Safely

The COVID-19 pandemic complicated solid organ donation and transplantation. As hospitals became overwhelmed by COVID-19 patients, transplants in all countries decreased. Even after most normal healthcare procedures resumed, it was unclear whether organs donated by COVID-19 patents could be transplanted safely and effectively.

New research, set to be presented next month at the European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), found that organs from donors with resolved COVID-19 are safe, and organs from donors with active COVID-19 may be considered if their infection was asymptomatic and they died of unrelated causes.

The research will be presented at the ECCMID 2022 conference in Lisbon, Portugal by Paolo Grossi, MD, PhD, a professor of infectious diseases at the University of Insubria in Varese, Italy and one of the lead investigators.

Grossi will be sharing the results of transplants he and his team conducted, 30 from donors with resolved COVID-19 and 38 from donors who had active COVID-19 at the time of their death. In September 2021, the Duke University School of Medicine began assessing organ transplants from donors who tested positive for COVID-19.

Donors were assessed by organ type, potential clotting in donated organs, and duration and severity of COVID-19 infection. After an average follow-up period of 46 days, none of the organ recipients had contracted COVID-19 through their transplant, and there were also no infections among the healthcare worker who treated the patients.

“Based on growing worldwide experience, we believe that organs from donors with past or active SARS-CoV-2 infection may be safely offered to candidates with immunity against SARS-CoV-2 because of previous infection or vaccination.” Grossi said. “This might contribute to increase the donor pool.”

One study of 22 countries found that organ transplants dropped by 15.92% from April 2020-March 2021. The decrease was most significant for kidney transplants (-19.14%), followed by lung (-15.51%), liver (-10.57%), and heart (-5.44%) transplants.

“Kidney transplantation is not considered as critical and immediate as a life-saving procedure, thus many centers globally deferred kidney transplants when COVID-19 hit,” Grossi explained.

As the pandemic raged on, there was a global organ shortage. In May 2020, the Italian National Transplant Center decided that donors who were 14 days after clinical COVID-19 recovery with negative bronchoalveolar lavage could be assessed for organ donation. Italians patients on the waiting list for organ transplants must have a history of resolved COVID-19 and be triple vaccinated with an mRNA vaccine and evidence of serocoversion.

In the US, the Health Resources and Services Administration (HRSA) states that all organ donors are tested for COVID-19, among other routine disease and illness screenings. People who have recovered from COVID-19 can be organ donors, HRSA says, and though people with active COVID-19 are generally not accepted as donors, “in some rare cases, transplants from COVID-positive donors have been performed.”

Grossi said, “Regardless of donor screening, the center should have a discussion of risk-benefit with the recipient regarding transplantation during the ongoing pandemic and the recipient must sign a specific informed consent.”