Can Covid positive fatalities become organ donors?
Two years into the pandemic and the medical fraternity is fiercely debating if COvid victims can become organ donors
Mumbai Two years into the pandemic and the medical fraternity is fiercely debating if people who died after testing Covid positive can become organ donors. The guidelines of India’s National Organ and Tissue Transplant Organisation (NOTTO) do not allow organ donations from Covid infected donors. However, a few instances of such transplants conducted safely have been recorded in the West.
Indian doctors are now calling for a revival of the NOTTO guidelines and rooting for hospitals to take up such transplants under research protocols.
“If the donor, as well as the recipient, is selected carefully, such transplants can be undertaken safely,” said Dr Vivek Kute, a professor at the Institute of Kidney Diseases and Research Center-Institute of Transplantation Sciences, Gujarat, who has been advocating for the revival of the NOTTO guidelines.
“For instance, if the recipient is young, has immunity against Covid through vaccination or previous infection, but has a higher chance of deteriorating or succumbing due to being on the waiting list for the organ, such a patient is likely to be a right candidate for an organ transplant, even if the organ comes from a positive donor,” said Kute. “Doctors can also consider the Cycle Threshold (CT) value of the RT-PCR test of a positive donor to ascertain the viral load before considering their organs for transplant,” he added.
Kute and his colleagues conducted a literature review about transplants wherein the donors had prior or active Covid infections. The review published in the Nature Public Health Emergency Collection in October 2021 highlighted cases wherein organs from Sars-CoV-2-positive donors were transplanted, either to recipients with evidence of prior infection or to Covid-19-naïve recipients considered at too high a risk of waitlist mortality to wait for an uninfected donor.
“Among those who received kidney allografts from donors with active Covid-19 infection, the incidence of delayed graft function (failure of the renal transplant to function immediately) is higher,” the review noted.
“The preference for a lung transplant is very low, due to the obvious reasons that SARS-CoV-2 infects the lungs. But transplant teams must gradually look at the careful selection of donors and recipients to establish the safety of such transplants and avoid organ wastage,” said Kute.
Last month, researchers at Johns Hopkins Medicine published a case of successful and safe transplantation of a kidney from a donor who died of Covid complications. “What distinguishes this case from others is the fact that we studied the donor kidney by using pre-transplant biopsy samples to investigate the presence of the virus,” said Kyungho Lee, a Johns Hopkins Medicine fellow and first author of the manuscript was quoted in a media release. “Instead of just doing a nasal swab test on the recipient after the transplant to check for infection after the fact, we obtained the donor kidney tissue prior to transplant and studied it carefully,” he said.
The research team noted that decisions on whether to accept organs other than lungs from donors who have died from Covid-19-related causes should be made on a case-by-case basis, but the risk of Covid-19 transmission through kidney transplant appears to be very low based on their cases to date.
Dr SK Mathur, president of the Zonal Transplant Coordination Centre (ZTCC) said that the debate on the risk-benefit ratio of conducting such transplants is ongoing. “It’s ideal for medical teams to undertake such transplants as research after seeking proper permissions from the Indian Council of Medical Research (ICMR),” he said.
An average of 2,50,000 kidney patients, 80,000 liver patients and 50,000 heart patients need transplants every year in India. Commonly, doctors take biopsies of the donor organs to rule out malignancies, fibrosis and any other condition that may deem the organ unviable. According to Mathur, the specialised molecular tests to determine whether the organ from a Covid positive donor is fit for transplant are not available in India.
For instance, in the case reported by the Johns Hopkins Medicine team, the researchers collected tissue samples from the donor’s kidney and aorta (a blood vessel known to have a high level of receptors for SARS-CoV-2, the virus that causes Covid-19) and tested by PCR and by a technique called in situ hybridization.
“There is very limited safety and efficacy data available on such transplants at the moment,” said Dr Akash Shukla, joint director, Regional Organ and Tissue Transplant Organisation (ROTTO) in Mumbai. “We can’t change our policies as there is not enough evidence. But we will soon have more data as more and more centres globally are now attempting such cases,” he said.