Dr. Timothy Pruett
Chair, American Society of Transplant Surgeons COVID Strike Force
Dr. Lewis Teperman
Chair, American Society of Transplant Surgeons COVID Strike Force
At the beginning of the pandemic, live organ donation significantly decreased, but is now recovering. This life-saving procedure often benefits patients who cannot wait for a pandemic to end. The American Society of Transplant Surgeons (ASTS) COVID Strike Force has summarized the current understanding of prior SARS-CoV-2 infection and potential organ donation to advise both transplant professionals and their patients.
There are two major issues to address:
Organ acquisition
The first is the safety of healthy people in organ acquisition (recovery team/healthcare providers and live donors).
Individuals with active (PCR+) COVID-19 infection should not be pursued as organ donors because: the retrieval team is at risk and the potential for large inoculum exposures exists; and there’s risk of respiratory issues, ICU/intubation, and death is higher for live organ donors infected with COVID-19, even in asymptomatic cases. Therefore, a negative PCR prior to surgical live organ donation is required.
Individuals with prior infections should wait at least seven weeks from their initial symptoms/positive PCR, be assessed for pulmonary status, and repeat the PCR to ensure virus is undetectable before proceeding with donation (see “Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study,” The Lancet,; “Postoperative In-Hospital Morbidity and Mortality of Patients With COVID-19 Infection Compared With Patients Without COVID-19 Infection,” JAMA Network Open; and “Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study,” Anaesthesia 2021).
Full vaccination is recommended for live organ donors prior to donation. A one-week quarantine period prior to donation is still suggested, especially in areas where COVID-19 infections are highly prevalent.
Organ quality
The second issue is the impact of prior COVID-19 infection on organ quality (both for live and deceased donors).
COVID-19 can be associated with significant organ damage. Any donor who contracted COVID-19 requires thorough assessment prior to retrieving lungs for transplantation, but other organ damage is also possible and should be assessed prior to retrieval. The time to resolution of COVID-19-induced organ damage is not clear at this time, however, it is incumbent that the retrieving centers assess organ quality based on prior infection.
Bronchial lavage for COVID-19 is crucial for lung transplantation. COVID-19 has been conveyed during lung transplantations; thus the requirement for a deep endotracheal sample, even when there is a negative nasopharyngeal sample.