COVID-19 positive donor for solid organ transplantation

Abstract

The COVID-19 pandemic has significantly changed organ donation and transplantation worldwide. Since the beginning of the pandemic, the uncertainty regarding the potential route of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has created tremendous pressures on transplantation communities, and international organisations have advised against using organs from deceased donors who have tested positive for SARS-CoV-2. The possibility of SARS-CoV-2 transmission through organ donation has only been reported for lung transplantation; hence, based on current experience, transplantation of non-lung organs from donors with active SARS-CoV-2 infection has been considered possible and safe, at least over short-term follow-up. As the evolving outbreak of SARS-CoV-2 continues, alongside the presence of vaccines and new treatment options, clinicians should consider transplanting organs from deceased donors with active SARS-CoV-2 infection to recipients with limited opportunities for transplantation and those with specific natural or vaccine-induced immunity. This article proffers an expert opinion on the use of organs from deceased donors with resolved or active SARS-CoV-2 infection in the absence of more definitive data and standardised acceptance patterns.

Keywords: SARS-CoV-2; donor; recipient; transplant.

Fig. 1

Summary of Italian recommendations for selection of deceased donors with previous SARS-CoV-2 infection and target recipients. BAL, bronchoalveolar lavage; NPS, nasopharyngeal swab; RT-PCR, real time reverse transcription polymerase chain reaction; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.

Fig. 2

Summary of Italian recommendations for selection of deceased donors with active SARS-CoV-2 infection and target recipients. (A) Asymptomatic COVID-19 Infection: Detection of SARS-CoV-2 in a respiratory sample without current or past symptoms compatible with COVID-19. Mild COVID-19: Detection of SARS-CoV-2 in a respiratory sample in patients with symptoms consistent with COVID-19 who did not require oxygen supplementation or inpatient hospitalisation for COVID-19. (B) Elapsed time should be evaluated on an individual basis with a second opinion from an infectious diseases specialist. (C) In case of absence of available immunological response, it is recommended not to increase the ischaemic time while waiting for the result and to evaluate indication on an individual basis with a second opinion from an infectious diseases specialist. (D) Kidney recipients who are candidates for kidney transplantation and who test positive for SARS-CoV-2 must be suspended from the waiting list and can be re-entered 14 days after documented virological cure. BAL, bronchoalveolar lavage; NPS, nasopharyngeal swab; RT-PCR, real time reverse transcription polymerase chain reaction; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.