Transplanting Thoracic COVID-19 Positive Donors: Overcoming the Pandemic

PURPOSE: The COVID19 pandemic has exacerbated the thoracic organ shortage. Safe donation from COVID19 infected donors would increase the donor pool. METHODS: We present our institutional protocol and early results for thoracic organ transplantation using COVID19 positive donors. ENDPOINTS: To date, we performed 10 thoracic organ transplants in 9 recipients using organs from COVID19 positive donors (9 hearts;1 pair of lungs). Patient and graft survival to date is 100%, 91%. Hearts were procured from donors testing positive for COVID19 on upper and/or lower respiratory tract specimens, provided severe COVID pneumonia or myocarditis was not the cause of death, and hypercoagulable complications were absent. Lungs were procured only if donors were first positive >20 days prior and were PCR-negative on bronchoalveolar lavage. Cycle threshold, duration of infectivity and urgency of recipient need were considered in addition to routine evaluations.8/10 donors were first detected positive during terminal illness, yet no heart recipients acquired COVID19 infection through transplant and no unexpected rejection occurred. 1 heart-liver recipient required a redo heart transplant due to massive hemorrhage followed by hypercoagulability and coronary thrombus. An RV biopsy from the donor heart demonstrated ischemic changes and SARS-CoV-2 immunohistochemical findings suspicious for myocyte infiltration. Urgent re-transplantation was successfully completed utilizing a heart from another COVID19+ donor with no recurrence of hypercoagulability. One patient received lungs from a donor with mild COVID19, first detected 38 days earlier, yet still COVID19 positive on nasopharyngeal swab but not on BAL. No procurement or care team members became infected with covid as a result of this protocol. While limited, our experience to date supports that use of hearts from COVID19 positive donors is safe and effective. Lung transplantation from COVID19 positive donors is unresolved but may be cautiously pursued under the restricted circumstances.