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.

Liver transplantation from active COVID-19 donors: A lifesaving opportunity worth grasping?

“…So far, 11 SARS‐CoV‐2 infected donors (active COVID‐19), diagnosed after donation, without transmission to 18 different recipients have been published (one living liver donor, one platelet transfusion, two allogenic hematopoieticstem cell transplantations, and 13 kidneys and one liver from deceased donors). 7 , 10 , 11 , 12 , 13 , 14 …”

COVID-19 in the Immunocompromised Host, Including People with Human Immunodeficiency Virus

“…A recent report of 10 patients who received kidneys from SARS-CoV2 positive donors, reported good outcomes in all patients, without the development of active COVID infection. 104 However long- term data in large samples is still lacking. Based on the data above, accepting lungs from SARS-CoV2 positive donors must be deferred.…”

Lung donation and SARS‐CoV‐2 transmission: Missed detection versus missed opportunity?

“…Several cases of liver, kidney, and heart transplantation with organs from RT‐PCR positive donors have been reported but no donor‐derived SARS‐CoV‐2 transmission has occurred. 7 , 8 …”

“…6 Several cases of liver, kidney, and heart transplantation with organs from RT-PCR positive donors have been reported but no donor-derived SARS-CoV-2 transmission has occurred. 7,8 Despite the observation of SARS-CoV-2 RNAemia, no cases of transmission through blood product or stem cell transfusions have been reported. 9 The viral load detected in blood samples of COVID-19 patients is typically low (Ct value >30) and virus has not been isolated from blood in cell culture, suggesting that the potential for hematogenous transmission of SARS-CoV-2 is low.…”