Use of SARS-CoV-2-infected deceased organ donors: Should we always "just say no?"

被引:67
作者
Kates, Olivia S. [1 ]
Fisher, Cynthia E. [1 ]
Rakita, Robert M. [1 ]
Reyes, Jorge D. [2 ]
Limaye, Ajit P. [1 ]
机构
[1] Univ Washington, Div Allergy & Infect Dis, Seattle, WA 98195 USA
[2] Univ Washington, Div Transplant Surg, Seattle, WA 98195 USA
关键词
donors and donation; deceased; donor-derived infections; editorial; personal viewpoint; ethics; ethics and public policy; infection and infectious agents - viral; infectious disease; organ acceptance; organ procurement and allocation; organ transplantation in general; DISEASE TRANSMISSION; INFLUENZA; INFECTION; BLOOD; PATIENT; EVENTS; RISK; COV;
D O I
10.1111/ajt.16000
中图分类号
R61 [外科手术学];
学科分类号
摘要
In the context of a rapidly evolving pandemic, multiple organizations have released guidelines stating that all organs from potential deceased donors with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection should be deferred, including from otherwise medically eligible donors found to have mild or asymptomatic SARS-CoV-2 discovered on routine donor screening. In this article, we critically examine the available data on the risk of transmission of SARS-CoV-2 through organ transplantation. The isolation of SARS-CoV-2 from nonlung clinical specimens, the detection of SARS-CoV-2 in autopsy specimens, previous experience with the related coronaviruses SARS-CoV and MERS-CoV, and the vast experience with other common RNA respiratory viruses are all addressed. Taken together, these data provide little evidence to suggest the presence of intact transmissible SARS-CoV in organs that can potentially be transplanted, specifically liver and heart. Other considerations including ethical, financial, societal, and logistical concerns are also addressed. We conclude that, for selected patients with high waitlist mortality, transplant programs should consider accepting heart or liver transplants from deceased donors with SARS-CoV-2 infection.
引用
收藏
页码:1787 / 1794
页数:8
相关论文
共 48 条
[1]   End-stage liver disease patients with MELD >40 have higher waitlist mortality compared to Status 1A patients [J].
Ahn, Joseph ;
Bhuket, Taft ;
Mosadeghi, Sasan ;
Frenette, Catherine ;
Liu, Benny ;
Wong, Robert J. .
HEPATOLOGY INTERNATIONAL, 2016, 10 (05) :838-846
[2]   Histopathology of Middle East respiratory syndrome coronovirus (MERS-CoV) infection - clinicopathological and ultrastructural study [J].
Alsaad, Khaled O. ;
Hajeer, Ali H. ;
Al Balwi, Mohammed ;
Al Moaiqel, Mohammed ;
Al Oudah, Nourah ;
Al Ajlan, Abdulaziz ;
AlJohani, Sameera ;
Alsolamy, Sami ;
Gmati, Giamal E. ;
Balkhy, Hanan ;
Al-Jahdali, Hamdan H. ;
Baharoon, Salim A. ;
Arabi, Yaseen M. .
HISTOPATHOLOGY, 2018, 72 (03) :516-524
[3]  
*AM SOC TRANSPL, 2020, COVID 19 COR FAQS OR
[4]  
*AM SOC TRANSPL SU, 2020, ORG RETR TRANSPL COV
[5]  
American Association for the Study of Liver Diseases, 2020, CLIN INS HEP LIV TRA
[6]  
*ASS ORG PROC ORG, 2020, COVID 10 COR B UPD M
[7]  
*CAN BLOOD SERV, 2020, COVID 19 INF
[8]   Evidence of Renal Infection in Fatal Cases of 2009 Pandemic Influenza A (HI NI) [J].
Carmona, Fabio ;
Carlotti, Ana P. C. P. ;
Ramalho, Leandra N. Z. ;
Costa, Roberto S. ;
Ramalho, Fernando S. .
AMERICAN JOURNAL OF CLINICAL PATHOLOGY, 2011, 136 (03) :416-423
[9]   No evidence of SARS-CoV-2 RNA among blood donors: A multicenter study in Hubei, China [J].
Chang, Le ;
Yan, Ying ;
Zhao, Lei ;
Hu, Guibin ;
Deng, Lijuan ;
Su, Dan ;
Peng, Dongju ;
Nie, Xinjiao ;
Wang, Song ;
Li, Yuanyuan ;
Wang, Jundao ;
Ruan, Zhong ;
Gao, Shouliang ;
Yang, Huasong ;
Guo, Fei ;
Wang, Lunan .
TRANSFUSION, 2020, 60 (09) :2038-2046
[10]   Severe Acute Respiratory Syndrome Coronavirus 2 RNA Detected in Blood Donations [J].
Chang, Le ;
Zhao, Lei ;
Gong, Huafei ;
Wang, Lunan ;
Wang, Lan .
EMERGING INFECTIOUS DISEASES, 2020, 26 (07) :1631-1633