Heart Donors Who Had COVID May Increase Risk of Death for Transplant Recipients: Study

Potential heart donors with an active COVID-19 infection may have organ tissue damage that is not detectable until after a transplant has occurred, according to researchers.

A new study suggests that transplant recipients may face an increased risk of death if they received a heart from a donor who was COVID-19 positive, highlighting the need for more stringent screening of donor organs, which may be compromised by a viral or bacterial infection.

In findings published this month in the Journal of the American College of Cardiology (JACC), researchers indicate people receiving heart transplants from active COVID-19 donors are almost 7% more likely to die within six months after the transplant than those who receive hearts from non COVID-19 donors.

Researchers also found that at one-year post transplant, the mortality risk for active COVID-19 heart recipients is 14% higher than those with non COVID-19 transplanted hearts, indicating that potential tissue damage of an active COVID-19 donor heart may not resolve over time.

The study comes as medical experts are increasingly concerned about the potential health implications of donor organs from people who are compromised by COVID-19 or other infections.

COVID-19 Organ Transplant Donor Concerns

Data has long shown the risks associated with organ transplants from people with undiagnosed infections, including a 2013 study that linked an undetected rabies infection with eight organ donor transplant deaths.

But the COVID-19 pandemic further underscored the potential damage an active viral or bacterial infection can impart on the body’s organs and how transplant recipients may be at increased risk of fatal complications post transplant.

Case reports in recent years, such as a 2021 incident where a patient received COVID-19 infected lungs during a transplant and died two months later, have convinced some health industry insiders that specific guidelines regarding organ donors with active Covid-19 infections should be implemented.

Currently, there is no consensus in the medical community on how to evaluate heart transplant donations from people with an active COVID-19 infection at the time of their death.

Active COVID-19 Heart Donors May Have Undetectable Tissue Damage

For this study, researchers from Montefiore Medical Center in New York examined 27,000 donors in the United Network for Organ Sharing (UNOS) between May 2020 and June 2022. They determined that 1,017 of those donors had active COVID-19 status, meaning they tested positive within two days of organ procurement. Of those active COVID-19 status donors, the researchers identified 239 whose hearts were transplanted.

The researchers determined those who received heart transplants from active COVID-19 donors had a six-month post transplant mortality risk of 13.8%, compared to a 7% mortality risk of people with non COVID-19 transplanted hearts. At one year post transplant, those with hearts from active COVID-19 donors had an even higher risk of mortality, at 23.2% versus 9.2% for people with hearts from non-COVID-19 donors.

Researchers suggested the elevated risk of death from active COVID-19 donor hearts may be caused by muscle and tissue damage to that organ from the virus, and that the damage may not be detectable until after a transplant has taken place.

To reduce risks to heart transplant recipients, the researchers stressed the importance of adopting universal guidelines for evaluations of heart donations from active COVID-19 donors, as well as multiple COVID-19 tests for organ donors prior to procurement.

“These early trends should be concerning enough such that heart transplantation centers need to thoroughly evaluate and continue to weigh the risks/benefits of using hearts from active COVID-19 donors,” said lead researcher Shivank Madan in a press release regarding the study.