Duke Health specialist explains how COVID-19 has affected organ transplants

Coronavirus

DURHAM, N.C. (WNCN) – The effects of COVID-19 have been challenging as doctors and scientists have had to figure it all out in real-time as the pandemic surged. That includes what the disease means for organ transplants.

“Here in COVID, it’s taken us some time to appreciate the safety issue. You know, we did not transplant patients who had passed away from COVID last year until we learned enough about how this would work,” said Dr. Cameron Wolfe, a specialist in transplant-related infectious diseases at Duke Health.

Organ transplants from COVID-19-positive patients now come with strict safety measures and several important distinctions. Did the donor die due to COVID-19 or did something else take their life, but they’re also infected?

“There’s a big difference if you think, for example, of someone who died as a result of COVID and complications, we have to be really careful on how we assess that donor versus someone who may have incidentally had COVID but were becoming a donor because they had a car crash.

“You’ll always be interested in what the organ quality is. We’re not going to put a potential organ recipient who’s in need of a transplant through complicated surgery if we don’t think they’re going to come out of that without a really life-affirming, life-saving, good, quality organ. It is true that there are some people who unfortunately continue to pass away from complicated COVID who, as a result of the difficulties of their illness, suffer kidney injury, suffer scarring of their lungs, have problems with their heart or their liver because of the medication or the treatments or COVID itself where it has so damaged their organs that they would not be suitable for transplantation.

“Are they a living organ donor, which is such a gift when someone comes forward. So, that’s part of the assessment is to say how good quality are those organs. In other cases, are they a living organ donor? In that situation, you have time up your sleeve. So, for that person who wants to become say a living kidney donor, we can simply wait and their donation can happen once they’re fully recovered.”

Potential organ donors are first tested with the traditional swab.

“Anyone who’s being evaluated for potential donation goes through the assessments of both the standard sort of swabs we’re all probably familiar with to see if there’s COVID in the nose or pharynx, then very specifically a bronchoscopy, so a wash of the lungs, to see if there’s COVID sort of deep down in the chest. And to use that information to inform decision making in is this going to be safe or is this something we have to say no to,” Wolfe said.

The measures are in place after several documented cases early in the pandemic where a donated lung infected the recipient. In those cases, it was not known that the patient was positive for COVID-19. Wolfe explained that the patient is not the only concern — so is the entire transplant team.

“We don’t want to inadvertently expose lots of other individuals who may be involved in the transplant process,” he said. “I do think there is very careful assessments that needs to happen for everyone’s sake.”

There are around 105,000 people in the United States waiting on a kidney transplant. It’s a significant reason why Wolfe believes they get this right.

“I think it’s incumbent upon us as transplant physicians, if I see someone who — heaven forbid, I don’t want them to be in a position where they’re passing away with COVID, this is preventable at this point — but if that’s going to happen, I want to give that person and their family every opportunity to give a donation as an organ transplant,” Wolfe said.

“It can be absolutely life-saving. The wrong move would be to say this is impossible. The right move always, I think in transplants, is to say, ‘OK, how can we try and do this safely?’ Because if I can find someone whose life is saved through a heart transplant, that is worth it time and time again.”

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