PUNE: Three years into the Covid pandemic, transplant surgeons in major cities have decided to cautiously start using incidental Covid positive brain-dead donors’ vital organs, except lungs, for transplant into needy patients.
Their logic is simple – the risk of contracting Covid infection has to be balanced against the risk of patients dying from end-stage organ disease.
Their confidence got a boost after a tean of doctors from Pune’s Command Hospital successfully transplanted two Covid-infected brain-dead donors’ kidneys into two needy patients in September this year. Both the recipients are doing well post-transplants.
Going a step further, transplant professionals’ apex bodies including the Indian Society of Organ Transplantation (ISOT), Liver Transplant Society of India (LTSI) and Indian Society for Heart and Lung Transplantation (ISHLT) have issued a consensus statement that calls for rethinking over the Centre’s present norm that disallows use of organs from Covid positive patients due to the fear of spread of disease or thrombotic (blood-clotting) complications in patients receiving these organs.
Experts are of the view that the norm was issued early during the pandemic, in 2020, and needs rethinking now as most of the adult population has either been infected with Covid, received two doses of vaccine, or both.
Besides,the current variants, despite being more infective, are associated with mild disease, especially in those who have been vaccinated, the experts said.
Living with Covid also means investigating whether organs from donors, who are incidentally found Covid positive, can be used with an acceptable risk–benefit ratio in select patients with end-stage organ failure, surgeons TOI spoke to on Thursday said.
“If the brain-dead donor was incidental Covid positive, admitted to hospital for other health reasons and died owing to complications other than Covid, then we shouldtransplant vital organs, barring the lungs, into needy patients after due consent from donor and recipient families. We have also sent this recommendation to the Union government’s apex body and urged it to revise the earlier norm that disallows it,” said Ahmedabad-based transplant physician Dr Vivek Kute, secretary of ISOT.
Since health is a state subject, zonal transplant coordination committees active in different cities are supporting the surgeons on a case-by-case basis. “So far, two kidney transplants that took place at Command Hospital in Pune are the only reported cases of organ donation from incidental Covid deceased donors andtheir successful transplants in India,” Dr Kute said.
Command Hospital’s nephrologist and transplant physician, Dr (Lt Col) Sudeep Prakash, who took the lead in the transplant in September this year, said the decision was spurred by the long list of needy patients. “Besides, last two years’ data and medical literature of various countries have clearly stated that, barring the lungs, transplant of other vital organs drawn from Covid positive deceased donors is completely safe,” he said.
“First I convinced our hospital committee and later sought permission from the Army headquarters in Delhi. Ihad to seek 50 permissions, including nods from the 64-year-old donor’s and recipient’s family members and immediate kin, before transplanting the kidney first into a46-year-old woman and later into a 29-year-old woman from another incidental Covid positive donor the same month,” Dr Prakash said. The first recipient had received the kidney from the brain-dead woman, who had suffered brain hemorrhage. She had incidentally tested positive for Covid at the time of donation.
When contacted, Dr Archana Kumari, a senior official from the National Organ and Tissue Transplant Organization, an apex national body of the Union government which frames norms and oversees organ donation and transplant in India, said, “The earlier norm framed in 2020 still prevails. Since Covid-19 is under research with many instances of long Covid and newer variants, Covid positive deceased donor’s organ donation has not yet been allowed for transplant. ”