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

Abstract

Point‐of‐care tests may play a valuable role in reducing the risk of donor‐derived SARS‐CoV‐2 transmission in lung transplantation.

Visualising SARS-CoV-2 infection of the lung in deceased COVID-19 patients

“… 9 , 35 This issue is becoming increasingly apparent in the clinical practice of lung transplantation with regard to the assessment of the suitability of potential donor lungs from individuals with a SARS-CoV-2 infection in the past - which is nowadays an element in the clinical history of most individuals around the globe. 36 We surmise that persistent positive-sense viral RNA molecules (intact or fragmented) may underlie the persistent weakly-positive qRT-PCR results on bronchoalveolar lavage fluid screening samples from candidate donors. In the absence of a longitudinal series of qRT-PCR results over a period of a few days, it is not possible to distinguish conclusively between a persistent viral RNA signal vs. a recently contracted infection.…”

Transplanting COVID-19 positive donors: Expanding our experience to widen the donor pool

“…Indeed, despite the observation of SARS-CoV-2 RNAemia, no transmission through a blood product or stem cell transfusions have been reported. 6 , 7 , 8 , 9 …”

“…One solution to narrow the window of uncertainty between the last RT-PCR and lung procurement and thereby reduce the likelihood of donor-derived viral transmission is to use point-of-care tests (POCTs) (rapid antigen test or nucleic acid amplification test) on BAL samples at the time of lung procurement. 9 Similarly, the duration of infectiousness might also be impacted by new SARS-CoV-2 variants and the diagnostic test used, making a 20-day window to define infectiousness and risk of transmission too short or (more likely) too long.…”