Large Variation in Heart Transplant Selection Practices During the COVID-19 Pandemic

PURPOSE: A growing proportion of transplant donors and recipients have a history of COVID infection. Transplant societies issued guidelines to support decisions regarding donor selection and recipient activation after COVID infection, but outcome data are still limited. This study sought to characterize heterogeneity in current clinical practice and opinions regarding cardiac donation after recipient or donor COVID infection. METHODS: An online survey was distributed to heart transplant clinicians through a professional society message board and social media. Responses were collected between September 29 and October 18, 2021. RESULTS: 204 healthcare professionals from diverse geographic regions (North and South America, Europe, Middle East, Asia and Australia) completed the survey, including 143 (70%) transplant cardiologists, 42 (21%) cardiac surgeons and 19 (9%) other heart transplant clinicians. 80% of clinicians felt COVID vaccine should be mandatory before transplant. There was significant variation in clinical practice for donor acceptance and recipient management, including several scenarios directly addressed by society guidelines - see Figure 1 for a sample of responses. CONCLUSION: There is significant variation in the clinical approach to common scenarios following donor or recipient COVID infection. This reflects continued uncertainty with post-transplant outcomes impacted by pre-transplant COVID infection. Granular outcome data are needed to better inform clinical decisions.