Solid Organ Transplantation from SARS-CoV-2–infected Donor to Uninfected
Recipients: First in the United Arab Emirates and the Neighboring Region

Fatima   A.   Al Dhaheri; Ahmed   A.   Al Hammadi; Reginaldo   C.   Boni; Amina   A.   Randhawa; Emmanuel   F.   Nsutebu; Mohamad      Mooty; Mohamed   Y.   Al Seiari; Stephen   G.   Holt; Ali   A.   Al Obaidli

doi:10.2174/04666230317104250

Abstract

Introduction: The lifesaving practice of organ donation and transplantation has been deeply impacted by the COVID-19 pandemic. Up until January 2022, donors were screened out of the donor pool in the UAE if they tested positive for SARS-COV-2.

Methods: We report a case of a COVID-19 infected donor whose organs were transplanted to 3 uninfected recipients (2 kidneys, 1 liver). A national guideline was created to permit a change in practice after the engagement and endorsement of relevant stakeholders. Recipients were informed of Donor’s COVID status and consented.

Results: The Donor was a 35-year-old previously healthy male who was hospitalized due to a spontaneous intracerebral bleed of unclear etiology and met brain death criteria. SARS-COV-2 PCR testing was obtained on admission and remained persistently positive beyond day 14 of admission. The donor was otherwise afebrile and had normal inflammatory markers with no evidence of an infectious pulmonary process on CT scan. The donor did not receive any COVID therapies. The donor had received 3 doses of the Sinopharm vaccine, the last dose being 3 months prior to admission. Organ retrieval occurred on day 24 of COVID-19 PCR positivity to three uninfected recipients in two different transplant centers in the UAE.

Conclusion: Transplanting solid organs from non-lung COVID positive donors can effectively maintain an expanded donor pool during the pandemic.

[1]
Aubert O, Yoo D, Zielinski D, et al. COVID-19 pandemic and worldwide organ transplantation: A population-based study. Lancet Public Health  2021; 6(10): e709-19.
 [http://dx.doi.org/10.1016/S2468-2667(21)00200-0] [PMID: 34474014]

[2]
GODAT. The global observatory on donation and transplantation. 2022.

[3]
Weiss MJ, Hornby L, Foroutan F, et al. Clinical practice guideline for solid organ donation and transplantation during the COVID-19 pandemic. Transplant Direct  2021; 7(10): e755.
 [http://dx.doi.org/10.1097/TXD.0000000000001199] [PMID: 34514110]

[4]
Kute VB, Fleetwood VA, Meshram HS, Guenette A, Lentine KL. Use of organs from SARS-CoV-2 infected donors: Is it safe? A contemporary review. Curr Transplant Rep  2021; 8(4): 281-92.
 [http://dx.doi.org/10.1007/s40472-021-00343-0] [PMID: 34722116]

[5]
Zidan A, Alabbad S, Ali T, et al. Position statement of transplant activity in the middle east in era of COVID-19 pandemic. Transplantation  2020; 104(11): 2205-7.
 [http://dx.doi.org/10.1097/TP.0000000000003348] [PMID: 32541561]

[6]
Jayasekera CR, Vikram HR, Rifat Z, et al. Solid organ transplantation From SARS-CoV-2–infected donors to uninfected recipients: A single-center experience. Transplant Direct  2022; 8(2): e1286.
 [http://dx.doi.org/10.1097/TXD.0000000000001286] [PMID: 35047665]

[7]
Romagnoli R, Gruttadauria S, Tisone G, et al. Liver transplantation from active COVID-19 donors: A lifesaving opportunity worth grasping? Am J Transplant  2021; 21(12): 3919-25.
 [http://dx.doi.org/10.1111/ajt.16823] [PMID: 34467627]

[8]
Alsuwaidi AR, Al Hosani FI, ElGhazali G, al-Ramadi BK. The COVID-19 response in the United Arab Emirates: challenges and opportunities. Nat Immunol  2021; 22(9): 1066-7.
 [http://dx.doi.org/10.1038/s41590-021-01000-5] [PMID: 34316063]

[9]
Al-Hosani F, Al-Mazrouei S, Al-Memari S, Al-Yafei Z, Paulo MS, Koornneef E. A Review of COVID-19 Mass Testing in the United Arab Emirates. Front Public Health  2021; 9: 661134.
 [http://dx.doi.org/10.3389/fpubh.2021.661134] [PMID: 34055725]

[10]
Wölfel R, Corman VM, Guggemos W, et al. Virological assessment of hospitalized patients with COVID-2019. Nature  2020; 581(7809): 465-9.
 [http://dx.doi.org/10.1038/s41586-020-2196-x] [PMID: 32235945]

[11]
Owusu D, Pomeroy MA, Lewis NM, et al. Persistent SARS-CoV-2 RNA Shedding Without Evidence of Infectiousness: A Cohort Study of Individuals With COVID-19. J Infect Dis  2021; 224(8): 1362-71.
 [http://dx.doi.org/10.1093/infdis/jiab107] [PMID: 33649773]

[12]
Al Madani AK, Al Obaidli AK, Ahmed W, AlKaabi NA, Holt SG. The Omicron COVID-19 threat to dialysis patients is dramatically lower than previous variants. Nephrology  2022; 27(8): 725-6.
 [http://dx.doi.org/10.1111/nep.14065]