Stanford's successful heart transplantation using COVID-19 positive donor
by Roxanna Van Norman
June 21, 2022
A team of heart surgeons and health care specialists from the Stanford Department of Cardiothoracic Surgery recently performed their first reported heart transplant on a patient using a COVID-19 positive donor.
"We looked at the quality of the donor organ, their characteristics, and COVID-19 history, and weighed that against the recipient needs," said Brandon Guenthart, MD, Clinical Assistant Professor of Cardiothoracic Surgery, who collaborated with Stanford's cardiothoracic surgeons, cardiologists, and other specialists on the procedure.
After carefully assessing the risks and benefits of both the donor and recipient, Stanford surgeons deemed that the donor and the organ met the criteria suitable for donation.
"As far as we know, we are the first reported transplant center on the West Coast to consider these donors, thereby expanding the donor pool and offering the chance of transplantation to more patients," said Guenthart.
The successful procedure took place earlier this year with William Hiesinger, MD, Assistant Professor of Cardiothoracic Surgery, performing the heart transplant. Stanford surgeons and cardiologists continue to follow the patient closely.
“To date, the patient continues to be doing well at home, has excellent graft function, and never experienced any signs or symptoms of COVID in the post-operative period,” said Hiesinger.
Potential donor organs
Transplant centers routinely screened potential donors for infections, including most recently for COVID-19. Until recently, a donor who tested positive for COVID-19 would not be eligible to donate due to uncertain risks of virus transmission.
"Initially, during the pandemic, if a donor had COVID-19, Stanford was careful to exclude them from being organ donors," said Guenthart, further noting this likely impacted the donor pool that was already in short supply against the high demand for life-saving organs in the United States. They were missing out on potential donor organs.
"We started to rethink our criteria [for donor organs] within the transplant community," said Guenthart. Some transplant centers began accepting COVID-19-positive donor organs where the donor had no active symptoms or had recovered from COVID-19 as a viable option for transplant.
The Organ Procurement and Transplantation Network (OPTN) recently updated its summary of evidence for COVID-19 donor evaluation and testing and considerations for organ acceptance from donors with a history of COVID-19.
Recently, new research from the Duke University School of Medicine looked at organ donation from deceased donors who tested positive for COVID-19 appeared to be safe and did not cause virus transmission in the patient receiving the organ.
As the pandemic persisted, Stanford surgeons began to evaluate organs that tested incidentally for COVID-19 in settings where they did not directly die as a result of the virus. They successfully utilized and implanted its first COVID-19 positive in the heart transplant patient.
Still, the transplant community, including Stanford surgeons and procurement specialists, continues to observe careful assessments of both donors and recipients on a case-by-case basis.
Heart transplants at Stanford
Stanford's transplant program is one of the most active and successful heart transplant centers in the United States. In 2021, Stanford performed 103 adult heart and heart-lung transplants - a record high from the previous years.
"If you come to Stanford, we will look at every possibility and work incredibly hard to find you a heart," said Guenthart, citing the hospital's shorter-than-expected wait times and track record of outstanding quality and outcomes in heart transplantation.
Stanford's long history of pioneering heart transplantation has provided more hearts to more people, including accepting donor organs from longer distances to provide faster access for patients to heart transplants and shorter wait times. Organ donation from COVID-19 positive donors could potentially help with the effects of the pandemic on discarded organs and the overall organ shortage.
“Accepting more organs for transplant means we can provide more hearts for more people while maintaining excellent outcome. Our incredible team ensure patients receive all available options and optimal care,” said Hiesinger.
Stanford will continue to be a leader in adopting new strategies and procedures based on the best available current data to increase the donor pool and offer life-saving transplantation to more patients.
Dr. Brandon Guenthart
Dr. William Hiesinger