Loading...
In all deceased potential organ donors, upper respiratory tract specimens are tested for SARS-CoV-2. If lung transplantation is being considered, lower respiratory tract specimens must also be tested. To date, no proven or probable cases of donor-to-recipient transmission of SARS-CoV-2 from nonlung donors have been reported. In light of the ongoing organ shortage as well as the desire to retain viable, potentially lifesaving organs for transplant, Cleveland Clinic investigators report recipient outcomes following transplant of 10 kidneys from 5 SARS-CoV-2–infected deceased donors.
Causes of death were unrelated to COVID-19 in all donors, and none had symptoms of COVID-19 prior to or during hospital admission. Potential recipients were informed of the positive donor test, and none declined the organ offer. Ten kidneys were procured from 5 donors. No documented transmission of SARS-CoV-2 occurred, and no recipient developed symptoms concerning for COVID-19. Full protective equipment was used for organ procurement, but not for organ implantation.
Koval CE et al. Early success transplanting kidneys from donors with new SARS-CoV-2 RNA positivity: A report of 10 cases. Am J Transplant 2021 Jul 13; [e-pub]. (https://doi.org/10.1111/ajt.16765)
Comment
Given the ongoing high rates of SARS-CoV-2 infection, it has become relatively common for potential organ donors to test positive for SARS-CoV-2 “incidentally.” Earlier during the pandemic, I generally declined SARS-CoV-2–infected donors unless the clinical situation indicated resolved infection with ongoing detection of SARS-CoV-2 RNA. Now, however, I accept most nonlung donors with positive testing but no clinical evidence of severe COVID-19. Most likely, SARS-CoV-2 (at least in patients without severe disease) resembles other respiratory viruses in that donor-to-recipient transmission is largely confined to lung transplantation. Accordingly, lungs from donors with proven or suspected SARS-CoV-2 infection should not be transplanted.