- The COVID-19 pandemic has exacerbated the ongoing organ donor shortage and raised key questions about the safety of organs donated from persons who test positive for SARS-CoV-2, the virus which causes COVID-19.
- Evidence outlined in a new research publication co-authored by Dr. Jason Goldman of Providence Swedish could help inform a response to the shortage.
- The researchers found that non-lung transplant recipients from positive donors have 30-day graft and patient survival rates similar to those using donors negative for SARS-CoV-2.
Among the many groups who have experienced challenges and disruptions in accessing healthcare and services during the COVID-19 pandemic, organ transplant candidates, donors, and their families have faced a particularly challenging conundrum. The demand for donated organs already exceeded demand, with some patients waiting months and sometimes years for a donor. But with so many people testing positive for SARS-CoV-2, the virus that causes COVID-19, is it safe to receive an organ from a SARS-CoV-2-positive donor?
A newly published national study led by Providence Swedish researcher Jason Goldman, M.D., M.P.H., aims to help answer that question. The study, published in the journal Transplant Infectious Disease, provides much-needed evidence about the use of organs from donors who recently tested positive for SARS-CoV-2.
To evaluate the safety of transplants from SARS-CoV-2-positive organ donors, Dr. Goldman, an infectious disease physician at the Organ Transplant and Liver Disease Center at Providence Swedish Hospital in Seattle, WA, along with more than two dozen national experts from the Organ Procurement and Transplantation Network (OPTN) ad hoc Disease Transmission Advisory Committee conducted the largest study on this question to date. The OPTN is a public-private partnership that links all U.S. donation and transplantation professionals, and the Committee considers issues related to disease transmission through organ transplantation.
The study drew on data including all U.S. donors and transplant recipients, as well as cases referred to the Committee for review of possible transmission from donor to recipient. Their review assessed 30-day outcomes for 1,241 transplant recipients from a donor testing positive for SARS-CoV-2, and 21,948 organ donors without a positive virus test. The analysis found that non-lung transplant recipients from positive donors have 30-day graft and patient survival rates similar to those using donors negative for SARS-CoV-2.
“Our findings are particularly heartening for patients and providers grappling with the dual challenges of an organ shortage and uncertainty about the safety of organ transplants during the COVID-19 pandemic,” explains Dr. Goldman. “Early guidance for transplant programs recommended avoiding donors who recently tested positive for SARS-CoV-2. However, this study provides key evidence that in most cases, transplants from SARS-CoV-2-positive donors can be used with excellent short-term outcomes,” he adds.
As a next step in this research, the committee identified a need for additional studies to look at long-term outcomes.
SARS-CoV-2 lower respiratory tract testing requirement improved safety for lung transplants
The researchers also evaluated the impacts of a 2021 OPTN emergency policy requiring Organ Procurement Organizations to conduct lower respiratory track testing for SARS-CoV-2. That policy was launched in late May 2021, after the Centers for Disease Control and Prevention (CDC) and the Disease Transmission Advisory Committee identified three cases where SARS-CoV-2 was passed to lung transplant recipients from the donor, after upper respiratory tract testing failed to identify the donors’ COVID-19 infections.
A retrospective analysis of all donors recovered and recipients transplanted in the U.S. looked at data between May 27, 2021, when the new LRT policy took effect, and January 31, 2022. Not only did they find that no probable or proven cases of COVID-19 transmission have occurred to recipients of non-lung organs, but they also found zero transmissions of COVID-19 to lung transplant recipients after the new policy requiring lower respiratory track testing in lung donors took effect.
While the researchers point to the need for additional study around long-term outcomes, this study provides key evidence for transplant recipients, donors, their loved ones and providers about transplant safety during COVID-19.