Kidney successfully transplanted from donor who died of COVID-19 after scientists tested tissue for virus

In this file image, University Health Network surgeons perform a kidney transplant. (courtesy University Health Network")

It may still be possible to safely use organs from donors with COVID-19, according to a new report on the successful transplantation of a kidney into a new patient from a person who had died of COVID-19 complications.

Kidney transplantation from donors infected with COVID-19 has been avoided due to fears that the organ could infect the new recipient.

While a handful of kidneys have been donated from people with COVID-19 during the pandemic, this is the first time that the full safety of the process was confirmed through tissue sampling that found no molecular evidence of the virus in the kidneys.

This strategy could help avoid the discarding of organs that might be perfectly safe, experts say.

Researchers at John Hopkins Medicine performed the transplant, the process of which is described in a report published earlier this month in the American Journal of Transplantation.

“What distinguishes this case from others is the fact that we studied the donor kidney by using pre-transplant biopsy samples to investigate the presence of the virus,” Dr. Kyungho Lee, a Johns Hopkins Medicine fellow and first author of the manuscript, said in a Monday press release.

“Instead of just doing a nasal swab test on the recipient after the transplant to check for infection after the fact, we obtained the donor kidney tissue prior to transplant and studied it carefully.”

The kidney came from a 30-year-old woman. She was otherwise healthy when she contracted COVID-19, but quickly worsened after being hospitalized in March 2021. She was placed on a type of life support called ECMO, which stands for extracorporeal membrane oxygenation, but eventually developed injury from lack of oxygen to the brain and was pronounced brain dead.

Although she was an organ donor, the question then arose: could her organs be safely transplanted into someone else who was in need?

A 55-year-old man with end-stage kidney disease was one such person in need, after having been on dialysis for five years. Doctors wanted to find a kidney for him, as those with kidney disease can languish on waiting lists for years.

“In this case, surgeon Dr. Desai informed me that an organ was available, but other centres had turned it down because the donor died from COVID-19 complications,” Dr. Hamid Rabb, medical director of the Johns Hopkins Kidney Transplant Program and corresponding author of the report, said in the release.

While doctors believed it would be safe, having confirmed the organ donor was negative for COVID-19 by PCR test three days before the transplant took place, they wanted to be sure.

So tissue samples were taken from the donor’s kidney and a blood vessel known to be vulnerable to SARS-CoV-2. Those samples were tested by PCR, and also by situ hybridization, a method which looks at specific DNA or RNA sequences, in order to see if there was any virus in the tissue itself.

After they found none, they compared the results to what a positive COVID-19 tissue example looked like to be sure.

Since the transplant occurred, the new recipient has tested negative for COVID-19 by PCR on day 20, 30 and 60 following the operation.

More than nine months since the transplant, he has excellent kidney function and has been able to end dialysis, researchers say.

“We know our case may not be representative of many possible COVID-19 donors, particularly since the donor was negative for COVID-19 at the time of transplantation,” Rabb said. “However, it’s a step forward using highly sensitive molecular testing to show it can be safe to use organs from deceased COVID-19 donors. Organs can be individually considered for kidney transplant instead of being routinely discarded.”

Although this is a promising first step, researchers pointed out that it is one kidney transplant, and more data on more transplants is needed before the process can be widely recommended.