Organ donation defies COVID? – Doctors report successful postmortem kidney donation

The possibility of using non-pulmonary organs from patients who have died of COVID-19 for transplantation could be an important option in times of the pandemic and general shortage of donor organs. So far, however, there is little data on this approach. Doctors from the Johns Hopkins University School of Medicine have successfully transplanted the kidney of a donor who died of COVID-19. They describe their approach in the American Journal of Transplantation.

donor and recipient

The 30-year-old donor had previously been diagnosed with severe COVID-19 pneumonia. As the disease progressed, hypoxic brain damage ensued, ultimately leading to brain death.

Renal function was stable throughout the hospital stay with a serum creatinine of 0.7 mg/dl. Three days before the donation, the SARS-CoV-2 PCRs in the bronchoalveolar lavage and in the nasopharyngeal swab were negative.

The recipient of the donor organ was a 55-year-old man with end-stage renal disease who had been on hemodialysis for 5 years due to hypertension.

Important preparation: Rule out COVID infection in the donor tissue

Before transplantation, a COVID infection of the transplant had to be ruled out. The organ removal was therefore preceded by the examination of kidney biopsies for the presence of SARS-CoV-2 RNA using in situ hybridization and quantitative RT-PCR. After the removal, the aortic tissue removed with the kidney was also examined because angiotensin converting enzyme 2 receptors are highly expressed in the vascular system. SARS-CoV-2 uses these enzymes as the main entry point. Since the examinations did not show any signs of SARS-CoV-2 in the donor tissue, the transplantation was carried out.

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After the transplant

To date, no complications have arisen: the recipient tested negative for SARS-CoV-2 in a nasopharyngeal swab using RT-PCR 20, 30 and 90 days after the transplantation. He also showed no signs or symptoms of COVID-19 disease. After an initial delay in transplant function requiring hemodialysis, the recipient’s kidney function has finally stabilized nine months post-transplant. The last measured creatinine value was 1.3 mg/dl.

Conclusion: low risk of transmission through kidney transplantation

The result suggests that the risk of SARS-CoV-2 transmission through a kidney transplant seems very low.

The authors also refer to other cases in which kidney transplants from SARS CoV-2-positive donors – in the case of asymptomatic and mild SARS-CoV-2 infection and severe COVID-19 lung disease – were successful.1,2 The decision whether to transplant or not is always made on a case-by-case basis. Therefore, they are calling for further studies to confirm their results and to investigate organ transplantation from COVID-19-sick donors in the long term.

For the article in the American Journal of Transplantation https://onlinelibrary.wiley.com/doi/10.1111/ajt.16956

Credentials:

  1. Koval CE, Poggio ED, Lin YC, et al. Early success transplanting kidneys from donors with new SARS-CoV-2 RNA positivity: a report of 10 cases. Am J Transplant. 2021;21(11):3743-3749.
  2. Meshram HS, Kute VB, Patel H, et al. A case report of successful kidney transplantation from a deceased donor with terminal COVID-19-related lung damage: ongoing dilemma between discarding and accepting organs in COVID-19 era!Transpl Infect Dis. 2021;23(5).

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