Transplantation of hearts from SARS-CoV-2 positive donors

Incidence of SARS-CoV-2 remains high in the population. Consequently, an increasing percentage of reported organ donors are also SARS-CoV-2 positive. Although donors may not have experienced COVID-19-related symptoms, there is a chance of unnoticed cardiovascular effects associated with this disease. Therefore, SARS-CoV-2 donor grafts have been regularly rejected for heart transplantation (HTx) for a long time. We hereby present three consecutive patients receiving grafts from SARS-CoV-2 positive donors (defined by the PCR cycle threshold value < 30). All patients underwent HTx after a previous triple mRNA vaccination (mRNA-BNT162b2 vaccine, Comirnaty) without adverse events and with a regular post-operative course. Cardiovascular magnetic resonance and endomyocardial biopsies confirmed excellent graft function without signs of rejection or viral myocarditis. After a mean follow-up of 135 days after HTx, all patients were in good conditions without heart failure, viral myocarditis, or SARS-CoV-2 infection. Thus, we conclude that HTx with SARS-CoV-2 positive donors seems safe and feasible.