Transplantation of organs from SARS-CoV-2-positive donors: Preliminary experience from Spain.

BACKGROUND: The utilization of non-lung organs from deceased donors with a positive polymerase chain reaction (PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the time of donation can be lifesaving, although the safety of this policy must be assessed. METHODS: This is a nationwide, prospective study, reporting the experience on the utilization of non-lung organs from SARS-CoV-2-positive donors between December 15, 2020 and May 31, 2022 in Spain. RESULTS: A total of 69 patients received a solid organ transplant (41 kidney, 18 liver, 8 heart, and 2 combined liver-kidney) obtained from 32 donors with a positive SARS-CoV-2 PCR at the time of donation (four of them with a cycle threshold value <30). All recipients tested negative for SARS-CoV-2 and were free of coronavirus disease 2019 (COVID-19) symptoms prior to transplantation. Nasopharyngeal swab turned positive for SARS-CoV-2 PCR in 4 (5.8%) recipients at 3, 8, 11, and 20 days after transplantation, though evidence did not support a donor-derived COVID-19. Four kidney recipients lost their grafts and two patients died: one heart recipient due to cardiogenic shock and one combined liver-kidney recipient due to lung hypertension and right heart failure. Graft losses and patient deaths were deemed unrelated to the donor SARS-CoV-2 status by the treating teams. No other adverse reactions were reported. CONCLUSIONS: This preliminary experience supports the safety of the use of organs other than lungs from SARS-CoV-2 PCR-positive donors, in alignment with previous series. However, the impact of SARS-CoV-2 infection upon organ quality should be established in future research.

Review of the allocation criteria for heart transplant in Spain in 2023. SEC-Heart Failure Association/ONT/SECCE consensus document.

Heart transplant (HT) remains the best therapeutic option for patients with advanced heart failure (HF). The allocation criteria aim to guarantee equitable access to HT and prioritize patients with a worse clinical status. To review the HT allocation criteria, the Heart Failure Association of the Spanish Society of Cardiology (HFA-SEC), the Spanish Society of Cardiovascular and Endovascular Surgery (SECCE) and the National Transplant Organization (ONT), organized a consensus conference involving adult and pediatric cardiologists, adult and pediatric cardiac surgeons, transplant coordinators from all over Spain, and physicians and nurses from the ONT. The aims of the consensus conference were as follows: a) to analyze the organization and management of patients with advanced HF and cardiogenic shock in Spain; b) to critically review heart allocation and priority criteria in other transplant organizations; c) to analyze the outcomes of patients listed and transplanted before and after the modification of the heart allocation criteria in 2017; and d) to propose new heart allocation criteria in Spain after an analysis of the available evidence and multidisciplinary discussion. In this article, by the HFA-SEC, SECCE and the ONT we present the results of the analysis performed in the consensus conference and the rationale for the new heart allocation criteria in Spain.

Can We Improve the Effectiveness of the Spanish Nondirected Donation Program?

BACKGROUND: A nondirected altruistic living kidney donor is a person who wants to donate a kidney to anyone in need. In 2010, the Spanish National Transplant Organization developed a national protocol to make the assessment of every potential nondirected living kidney donor. The aim of this study was to describe the potential donor pool and its characteristics and the overall effect of the program. MATERIAL AND METHODS: A retrospective analysis was performed using data from the Spanish National Registry of Transplant Activity, and the Nondirected Donors National Database, between 2010 and 2017. Data related to sociodemographic characteristics, main motivations toward donation, and causes of dismissal were collected from all potential donors. The assessment of each candidate was carried out in a step-by-step process based on the national protocol. RESULTS: Two hundred seventy-two people contacted us, showing interest in the nondirected kidney donation, only 203 people underwent the early triage, and 16 of them successfully completed the assessment proces s, representing 8% of the total. The main motivation toward anonymous donation (n = 161) was: social awareness (22%) and to improve the quality of life of other people (9%). One hundred eighty-two candidates did not proceed, due to medical and psychological contraindications (42%) or donor refusal after specific information about the donation process (33%). The number of utilized nondirected altruistic living donors was 13 out of 203 (6%) of the candidates who began the early triage. Twelve transplant chains and a direct donation were performed, which made 38 kidney transplants possible (2.9 transplants per nondirected donor). CONCLUSIONS: We have to continue working to optimize our program. Our next steps will be to review the evaluation process, to detect areas for improvement, to understand why we lost many possible donors, and to ascertain if any of the reasons could be avoided.