COVID-19 Donor Hearts Still Viable for Transplantation, Study Finds

Hearts from donors who were COVID-19 positive are safe for transplantation, according to an analysis of data that included the first 84 COVID-positive donor heart transplant recipients in the US.

With availability of donor organs a constant issue for transplantation centers in the US, results of the study, which suggest length of hospitalization, organ failure rate, risk of postoperative stroke or dialysis, and 30-day survival were similar between those who received COVID-positive donor hearts and those who did not, have major implications for future transplant recipients and donor eligibility requirements.

“These findings provide evidence that outcomes were similar at 30-days post-transplant among patients who received COVID-19-positive donor hearts, so the potential risks appear to be lower than expected,” said Eldrin F. Lewis, MD, MPH, chair of the Association’s Scientific Publishing Committee, an advance heart failure and heart transplant specialist, and chair of the division of cardiovascular medicine at Stanford University, in a statement. “In turn, this may help to address the shortages in donor hearts for transplantation and reduce waiting times, since people often get sicker as heart failure progresses while waiting for a donor heart to become available.”

Citing the desire to expand on smaller case series examining use of COVID-19 positive donor hearts, the current study was conductedby a team of investigators representing the David Geffen School of Medicine at the University of California Los Angeles and the University of Pennsylvania. Presented at the American Heart Association’s (AHA) Scientific Sessions 2022, the study was designed as a retrospectivi3 analysis of data from the United Network for Organ Sharing database related to adult heart transplants occurring from February 2021-March 2022.

For the purpose of analysis, investigators defined positive COVID-19 status as a positive nucleic acid application, antigen, or other COVID-19 within 7 days of transplants. Investigators pointed out the primary outcomes of interest, which included differences in incidence of graft failure, post-operative stroke and dialysis, length of stay, and 30-day survival, were assessed using Fisher’s exact testing and Kaplan-Meier survival estimates.

From their United Network for Organ Sharing database, investigators obtained information related to 3289 deemed eligible for inclusion in their analyses. Of these, 84 transplants used COVID-19-positive donor hearts. Investigators pointed out COVID-19-positive allografts had similar cold ischemic times as other allografts (3.7 vs 3.5 hours; P=.22) and use of hearts from COVID-19 positive donors increased throughout the study period (r=.79)

Upon analysis, results indicated those who received COVID-19-positive donor hearts had similar lengths of stay, (15 vs 17 days, P=0.19), rates of graft failure (2.4% vs 1.0%, P=0.22), post-operative stroke (0.0% vs 3.0%, P=0.18), postoperative dialysis (15.5% vs 13.4%; P=.52) and 30-day posttransplant survival (96.1% vs 97.0%; P=.63) compared to recipients of nonpositive donors. Among a subgroup of 4 deceased recipients of COVID-19-posiutive allografts, results suggested none died as the result of pulmonary or infectious causes.

“These findings suggest that we may be able to be more aggressive about accepting donors that are positive for COVID-19 when patients are in dire need of an organ for heart transplantation,” said study investigator Samuel T. Kim, BA, a third-year medical student at the David Geffen School of Medicine at University of California in Los Angeles.

This study, “Outcomes of COVID-19 Positive Donor Heart Transplantation in the United States,” was presented at AHA 2022.