US lacks uniform rules for COVID-19-positive organ donors

The U.S. lacks a universally accepted set of recommendations for when organs can safely be recovered from COVID-19-positive donors, The New York Times reported Nov. 8. 

In the early months of the COVID-19 pandemic, organs were simply not procured from virus-positive donors. 

"At the beginning of the pandemic, if you were positive, you just weren't going to be a donor. We didn't know enough about the disease," Glen Franklin, MD, medical adviser to the Association of Organ Procurement Organizations, told the Times

Now, however, there are varying approaches, with decisions largely made on a case-by-case basis. 

"It is really a risk-benefit calculation," said David Klassen, MD, CMO at the United Network for Organ Sharing, the organization that oversees the national organ transplant system. "Many people waiting for organs are deathly ill. Their life span may be down to a few days. If they don't get a transplant, they will not survive," he told the Times.

Since COVID-19 is a respiratory illness, surgeons have generally avoided transplanting the lungs of patients who died from the virus, though there is not such a uniform approach for other organs. 

"If somebody has active COVID and they're testing positive, we would not procure organs from that donor, none at all," Deepali Kumar, MD, president-elect of the American Society of Transplantation, told the news outlet. 

Some centers, however, will procure abdominal organs below the diaphragm, such as kidneys or livers, from COVID-19-positive donors as long as they were asymptomatic, Dr. Franklin told the Times

For donors testing negative who have had persistent symptoms or long COVID-19, however, organs are generally taken. 

"If we start turning down everyone who had had COVID-19 in the past, we'd be turning down a lot of organs," Dr. Kumar said. 

Still, there is some hesitancy regarding the safety of transplanting organs from patients who experienced debilitating symptoms long after their initial COVID-19 infection. While most long COVID-19 patients don't test positive for the virus, some researchers worry the virus is still present, hiding in reservoirs in the body, including some organs. 

"It's a tough ethical question. If the patient assumes the risk, should we do it?" Zijian Chen, MD, medical director of the center for post-COVID care at New York City-based Mount Sinai Health System, told the news outlet. 

To read the full New York Times story, click here.


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