**Note: the release below is a special early release from the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID 2022, Lisbon, 23-26 April). Please credit the conference if you use this story**
New research to be presented at this year’s European Congress of Clinical Microbiology and Infectious Diseases (ECCMID 2022, Lisbon, 23-26 April) shows that organ donation from dying donors testing positive for SARS-CoV-2 appears to be safe and does not cause COVID-19 in the patient receiving the donated organ. The study is by Dr Cameron Wolfe and Dr Emily Eichenberger and colleagues, from Duke University School of Medicine, Durham, NC, USA.
The COVID-19 pandemic has exacerbated the shortage of abdominal organs for donation by increasing organ discard rates, due to the unclear risks of using organs from COVID-19 infected donors. Donation from COVID-19-infected donors could help mitigate the effects of the ongoing pandemic on discarded organs and the overall organ shortage. However, little is known about optimal donor selection and recipient management techniques.
In this preliminary study, Drs Wolfe and Eichenberger and colleagues present their institutional protocol (see figure 1 chart, link below) and early results for abdominal organ transplantation using COVID-19 positive donors beginning in September 2021. Of course, not all organs from COVID-19 positive donors are suitable for transplant. Donors were assessed by considering organ type, the duration and severity of COVID-19 illness, whether any signs of hypercoagulable disease were present (meaning potentially increased clotting in the donated organ or vessels) as well as careful overall inspection at the time of organ procurement. The urgency of the transplant for the recipient was also taken into account when the risk was evaluated.
For example, if the organ to be donated was lung or intestine, it would only be considered if the donor last tested positive for COVID-19 more than 20 days ago, a timeline consistent with infection control practices of the US Centers for Disease Control and Prevention (CDC). If virus was found in the base of the lungs, the lungs were deemed unsuitable for transplantation, but other organs could still be transplanted safely, provided the donor was not dying from severe hyperinflammatory COVID-19 or showed signs of excessive clotting. Even after passing through all these barriers, doctors must still consider the ultimate cause of death for a donor and weigh up whether that is likely to negatively impact the organ quality and/or surgical risk.
To reduce the transplant risk further, recipients are now strongly encouraged to be fully COVID-19 vaccinated prior to surgery, although not all recipients in this preliminary study had had that opportunity, and in fact all four organ recipients in this study were unvaccinated. Dr Eichenberger explains: “Being unvaccinated can increase the risk for of severe COVID-19 in transplanted patients due to their immunosuppression drugs post-transplant. For that reason, we strongly encourage our patients on the waiting list to get vaccinated. However, being unvaccinated does not take someone off the organ transplant waiting list at our institution at this time.”
While a vaccinated donor is also desirable, as it likely reduces the risk of severe organ inflammation, unknown or negative donor vaccine status would not preclude the use of otherwise good quality organs from COVID-19 infected donors.
In this study, the team details the first 6 abdominal organ transplants performed using the protocol (2 livers, 2 kidneys/pancreas transplanted together) in 4 recipients using organs procured from 4 donors who tested positive for COVID-19 on nose-throat and/or lung specimens. Protocol-driven donor evaluation included additional review of organ quality, with all 4 donors undergoing macroscopic and/or microscopic biopsy review to confirm organ suitability. Donor and recipient characteristics are shown in the link below.
All donors first tested positive for SARS-CoV-2 during their terminal illness. One donor died from complications due to severe COVID-19 infection including pulmonary emboli (lung clots), and one died of a polymicrobial brain abscess likely triggered by antecedent COVID-19. The other two had mild or moderate COVID-19 disease and died from alternative causes (one a stroke caused by a brain bleed, the other of a drug overdose).
All 6 abdominal organs had stable graft function, with a median duration of recipient follow up of 46 days. No unexpected rejection occurred. No recipients acquired COVID-19 infection through transplant, and no healthcare worker transmissions occurred. One heart-liver recipient required a repeat heart transplant due to unrelated surgical complications and a blockage in a coronary artery (coronary thrombus) in the transplanted heart. Urgent heart re-transplantation was successfully completed using a heart from another COVID-19 positive donor (who was asymptomatic and died from a gunshot wound).
Dr Eichenberger says: “While limited, our experience to date supports the use of abdominal organs from COVID-19 positive donors as safe and effective, even those actively infected, or with lung disease caused by COVID-19.”
She adds that, while this preliminary study only covers these first six patients, the team at Duke has now performed 20 abdominal organ transplants using the protocol, with those results to form the basis of future abstracts/research papers. She says: “Reassuringly, no recipients or surgical / procurement team members have contracted COVID-19 as a result of this protocol, and the outcomes for the recipients appear consistent with expected transplant outcomes. The protocol has remained unchanged.”
As with other transplant centres worldwide, evidence for transplanted organs from donors with a history of COVID-19 is still in its infancy, and more studies are needed from various centres around the world to confirm these initially promising results.
Dr Emily Eichenberger, Duke University School of Medicine, Durham, NC, USA. Please e-mail with interview requests/questions. E) emily.eichenberger@duke.edu
Alternative contact: Tony Kirby in the ECCMID Media Centre. T) +44 7834 385827 E) tony@tonykirby.com
Notes to editors:
The authors declare no conflicts of interest.
This press release is based on abstract 0481 at the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) Annual Meeting to be held in Lisbon from 23-26 April. The material has been peer reviewed by the congress selection committee. There is no full paper at this stage, but the authors are happy to answer your questions. The research has not yet been submitted for publication.
Journal
Clinical Microbiology and Infection