Utilization of deceased donors during a pandemic: argument against using SARS‐CoV‐2–positive donors

• Published in: American Journal of Transplantation 2020-07, Vol.20 (7), p.1795-1799
• Main Authors: Shah, Malay B., Lynch, Raymond J., El‐Haddad, Hanine, Doby, Brianna, Brockmeier, Diane, Goldberg, David S.
• Format: Article
• Language: English
• Subjects: Betacoronavirus; Coronaviridae; Coronavirus Infections - prevention & control; Coronavirus Infections - transmission; Coronaviruses; COVID-19; Disease transmission; Donors; donors and donation; editorial/personal viewpoint; ethics and public policy; Ethics, Medical; Health care; Humans; infection and infectious agents – viral; infectious disease; Intensive Care Units; Medical ethics; Medical personnel; Occupational Exposure; organ allocation; organ procurement; organ procurement and allocation; Organ Transplantation - adverse effects; Organ Transplantation - trends; organ transplantation in general; Pandemics; Pandemics - prevention & control; Personal Protective Equipment; Personal Viewpoint; Personal Viewpoints; Pneumonia, Viral - prevention & control; Pneumonia, Viral - transmission; Resource Allocation; Resource utilization; Risk; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Tissue and Organ Procurement - ethics; Tissue and Organ Procurement - statistics & numerical data; Tissue and Organ Procurement - trends; Tissue Donors; United States
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/ajt.15969

Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has rapidly become an unprecedented pandemic that has impacted society, disrupted hospital functions, strained health care resources, and impacted the lives of transplant professionals. Despite this, organ failure and the need for transplant continues throughout the United States. Considering the perpetual scarcity of deceased donor organs, Kates et al present a viewpoint that advocates for the utilization of coronavirus disease 2019 (COVID‐19)–positive donors in selected cases. We present a review of the current literature that details the potential negative consequences of COVID‐19–positive donors. The factors we consider include (1) the risk of blood transmission of SARS‐CoV‐2, (2) involvement of donor organs, (3) lack of effective therapies, (4) exposure of health care and recovery teams, (5) disease transmission and propagation, and (6) hospital resource utilization. While we acknowledge that transplant fulfills the mission of saving lives, it is imperative to consider the consequences not only to our recipients but also to the community and to health care workers, particularly in the absence of effective preventative or curative therapies. For these reasons, we believe the evidence and risks show that COVID‐19 infection should continue to remain a contraindication for donation, as has been the initial response of donation and transplant societies. After reviewing current literature regarding SARS‐CoV‐2 organ involvement and impact on the healthcare system, the authors detail why COVID‐19 positive individuals should not be considered for organ donation at this time. See related article by Kates et al on page 1787.