Early success transplanting kidneys from donors with new SARS-CoV-2 RNA positivity: A report of 10 cases

Abstract

Transplantation of solid organs from donors with active SARS-CoV-2 infection has been advised against due to the possibility of disease transmission to the recipient. However, with the exception of lungs, conclusive data for productive infection of transplantable organs do not exist. While such data are awaited, the organ shortage continues to claim thousands of lives each year. In this setting, we put forth a strategy to transplant otherwise healthy extrapulmonary organs from SARS-CoV-2-infected donors. We transplanted 10 kidneys from five deceased donors with new detection of SARS-CoV-2 RNA during donor evaluation in early 2021. Kidney donor profile index ranged from 3% to 56%. All organs had been turned down by multiple other centers. Without clear signs or symptoms, the veracity of timing of SARS-CoV-2 infection could not be confirmed. With 8-16 weeks of follow-up, outcomes for all 10 patients and allografts have been excellent. All have been free of signs or symptoms of donor-derived SARS-CoV-2 infection. Our findings raise important questions about the nature of SARS-CoV-2 RNA detection in potential organ donors and suggest underutilization of exceptionally good extrapulmonary organs with low risk for disease transmission.

Keywords: clinical decision-making; clinical research/practice; donors and donation: deceased; infection and infectious agents-viral; infectious disease; kidney transplantation/nephrology.

FIGURE 1

Factors to consider when accepting extrapulmonary organs from SARS-CoV-2 RNA-positive organ donors to minimize the theoretical and unknown absolute risk for SARS-CoV-2 transmission to recipients and organ procurement teams and to minimize the potential subclinical effect on end organ function from SARS-CoV-2 infection and inflammatory syndromes. All such information may not be readily available or consistently reliable. The boxed region would be considered exceedingly low risk for most recipients by our program [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 2

Proposed monitoring strategy for recipients of allografts from donors with SARS-CoV-2 infection given proposed pathophysiology. Ideal testing strategy and practical testing strategy included, based on the availability of reliable and reasonable clinical tools. “X” tests would require research capacity. “0” tests: Our monitoring strategy