organs from deceased covid-positive donors could lead to more transplants in canada
'it’s not contagious. it’s quite safe to use those organs': ontario transplant medical expert
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carolyn munn has been far from home for two years. the wife and mother of two relocated to toronto, ontario, from new brunswick with her family while one of her young sons, josiah, remains on a list for a heart transplant.
“he’s in a good place right now. hopefully he stays well while we continue to wait,” she said. “the longer we wait, he will start to deteriorate.”
there are thousands of canadians just like josiah — more than 4,300 people as of december 2019, according to the canadian government — who are on a waitlist for an organ transplant. now, a new method in ontario is using deceased covid-positive patients as donors. with more than 36,000 deaths attributed to covid in canada, it could result in more matches and more life-saving surgeries.
“we would definitely be open to it,” said munn. “i think i would trust medicine at this point. if they’ve done it and they’ve seen positive outcomes, then why not? i mean, we’ve waited two years, and two years of his life has been spent here in toronto, with no family around, no real life.”
in ontario — the province that does the most transplant surgeries in the country — there have been four adults who have successfully received organs from deceased covid-positive donors as of the end of february, according to ontario health.
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“this is significant because there’s a huge, huge shortage of organs. it is so life-changing that we have to try to maximize the number of organ donors,” said dr. atul humar, director of transplant at the university health network in toronto. “during covid, the overall number of donors has gone down. it’s due to multiple reasons, including the icus being overwhelmed with covid patients.”
an organ — liver, kidney or heart — can be used two weeks after a donor’s positive covid diagnosis, which ensures the virus isn’t replicating. the function of the organ is carefully examined so that it’s safe for transplant. there has yet to be a case where the virus has been transmitted to a recipient, said humar, except for lung transplants.
dr. deepali kumar is the director of transplant infectious diseases at the uhn, who also participates in developing national guidelines on organ donation.
“we weren’t sure how much of a threat (covid) was to our organ donation and transplant system,” she said. “now we’re dealing with, again, the same kind of issues with the covid-positive donor: how to ensure the safety of our transplant recipient and our surgical team.”
while selecting organs for transplant, doctors are also checking for other viruses.
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“the majority of organs have at least one virus within them like cytomegalovirus (cmv) and we take appropriate steps to prevent complications from these viruses. however, this is different than the covid question because we’re only transplanting organs where there’s no risk of transmission of covid,” said kumar.
prior to receiving a covid-positive organ, she said the recipient would be informed and there is a “consent process.”
currently, each province is in charge of deciding on its own policy.
“for the most part, we’re fairly harmonized. we do have regular meetings across provinces,” said kumar. “let’s say ontario is starting this process now, other provinces are also thinking about starting this use of covid-positive donors.”
a national guideline could be “in the cards,” she added.
the journey for munn has been exhausting. her son, who was born in january 2020, has been on a waitlist for a heart transplant since he was five months old.
“he’s got a large hole in his heart, which we understood was going to be repairable, but after three-months-old his heart muscles weren’t growing the way they should. his heart is not strong enough to be able to repair that hole,” she said. “he has a pulmonary artery band that was placed at two weeks to reduce the oxygen going to his lungs because of that hole in his heart.”
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but the band is not a solution, munn said. “that band will get tighter and tighter and so his oxygen saturations will drop and he’ll start to turn blue after so long.”
transplants for many patients, like josiah, are urgently needed.
“our patients are waiting longer. many of them are getting quite sick while they’re on the waiting list, so for example, if you’re waiting for a liver transplant, there’s almost a 25 per cent chance of you dying while you’re waiting before an organ becomes available,” said humar.
long wait times for organ transplants existed before the pandemic, however covid has complicated matters, adding a layer of stress as patients avoided testing positive before surgery, putting themselves and their procedures in jeopardy.
“there’s always a risk of having an outbreak on a transplant ward,” said kumar. “we’re very, very careful in terms of our whole infection prevention strategy for our transplant patients because they are vulnerable.”
although transplant facilities in ontario are currently up and running, kumar said there is the possibility that another wave of covid outbreaks could lead to more delays.
“if the icu gets full of covid patients, how are we going to do transplants? because you need some icu beds to proceed with transplants,” she said. “there’s a lot of uncertainty in people’s minds, always. patients are dealing with that uncertainty while waiting.”
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munn said the isolation due to covid has made her experience harder. “we spent almost two years up in toronto now — 1,400 kms from home, living at the ronald mcdonald house,” she said. “it’s only one caregiver [at the hospital] and that’s the way it’s been since march 2020.”
doctors outside of canada are also starting to harvest deceased covid-positive patients as donors.
“there are reports from italy that they’ve used covid-positive donors,” said kumar. “they have been using them in europe.”
a report in the united states outlined that a 55-year-old man received a successful kidney transplant from a woman who had tested positive for covid. the case was unique because johns hopkins researchers tested the kidney itself for presence of the virus with a biopsy.
humar said that is not the exact method being used in ontario. “our feeling, and most of the transplant community, is that that’s not necessary to do. even if you take a biopsy of the organ and you detect covid by pcr, as long as it’s more than two weeks after the diagnosis of covid, that virus is no longer replicating,” he explained. “it’s not contagious. it’s quite safe to use those organs.”
the lungs of covid-positive donors are not being used for transplants in the province at this time, however. they can be used if the donor tests negative prior to the transplant, “provided the function is good,” he said.
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“what we started with is the first category of patients, so those who had covid but then were negative on our testing,” said humar. “then, just within the last few weeks, we added onto that patients who had covid and were still covid-positive… it’s fairly recent.”
while kumar doesn’t see deceased covid-positive patients as a “holy grail” that can solve the organ shortage, she does think it could help by providing some additional organs.
although older covid-positive donors may not be suitable because of other medical conditions, kumar said young donors who “happen to have covid” but died of something else have organs that “could likely be utilized.”
for patients, and parents of patients like munn, it offers hope.
“the option of (doing) this,” she said, “and getting out of here and going back to a normal — in our own home — setting, it would definitely be huge.”
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