Transplantation of organs from SARS‐CoV‐2‐positive donors: Preliminary experience from Spain

Abstract

AbstractBackgroundThe utilization of non‐lung organs from deceased donors with a positive polymerase chain reaction (PCR) for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) at the time of donation can be lifesaving, although the safety of this policy must be assessed.MethodsThis is a nationwide, prospective study, reporting the experience on the utilization of non‐lung organs from SARS‐CoV‐2‐positive donors between December 15, 2020 and May 31, 2022 in Spain.ResultsA total of 69 patients received a solid organ transplant (41 kidney, 18 liver, 8 heart, and 2 combined liver–kidney) obtained from 32 donors with a positive SARS‐CoV‐2 PCR at the time of donation (four of them with a cycle threshold value <30). All recipients tested negative for SARS‐CoV‐2 and were free of coronavirus disease 2019 (COVID‐19) symptoms prior to transplantation. Nasopharyngeal swab turned positive for SARS‐CoV‐2 PCR in 4 (5.8%) recipients at 3, 8, 11, and 20 days after transplantation, though evidence did not support a donor‐derived COVID‐19. Four kidney recipients lost their grafts and two patients died: one heart recipient due to cardiogenic shock and one combined liver–kidney recipient due to lung hypertension and right heart failure. Graft losses and patient deaths were deemed unrelated to the donor SARS‐CoV‐2 status by the treating teams. No other adverse reactions were reported.ConclusionsThis preliminary experience supports the safety of the use of organs other than lungs from SARS‐CoV‐2 PCR‐positive donors, in alignment with previous series. However, the impact of SARS‐CoV‐2 infection upon organ quality should be established in future research. image