Transplant centers are adding organs from COVID-positive donors to supply

February 1, 2023


Dr. John A. Goss admits to having been a bit tense back in late 2021 when Baylor St. Luke's Medical Center in Houston decided to start using some organs from COVID-positive cadaver donors for transplants.


Goss is medical director of transplantation at Baylor St. Luke's, the site of the nation's first successful heart transplant. Goss is also a professor and chief of the division of abdominal transplantation at Baylor College of Medicine. In 26 years, he's performed more than 2,000 transplants, most of them at Baylor St. Luke's. The hospital is part of St. Luke's Health, a system whose parent is CommonSpirit Health.

Once the medical community figured out how to check the spread of COVID through infection control measures and vaccination, Goss says he and his colleagues at Baylor St. Luke's decided the need for organs outweighed any potential risks from transplanting organs from deceased donors who had tested positive for COVID but whose deaths were unrelated to the virus.

Since that decision was made in November 2021 and through mid-January, the medical center had transplanted more than two dozen organs — 20 livers, six kidneys and two hearts — from COVID-positive cadavers with no evidence of COVID infection or other adverse effects in the recipients. "At the beginning we were kind of nervous, but now we just follow the protocol," Goss says.

Dr. Raquel García-Roca, program director of abdominal transplant and surgical director of renal transplant at Loyola University Medical Center in suburban Chicago, demonstrates robotic technology that she and other surgeons use for transplants. The medical center's transplant center is among those transplanting organs from COVID-19 positive donors.
Credit: Loyola Medicine

"We really don't even think about it much anymore because we've done so many of them and we know there hasn't been any spread."

Evidence-based practice
Transplant centers across the nation have seen similar success in the use of organs from COVID-positive patients, both living and deceased, according to evidence compiled by the Ad Hoc Disease Transmission Advisory Committee of the Organ Procurement & Transplantation Network. The network is the public-private partnership that links professionals involved in the U.S. donation and transplantation system.

The committee's most recent report covers evidence from various scenarios involving COVID-positive donors. Among the findings it points to is that deceased donors who did not have active COVID symptoms when they tested positive 21-90 days after the onset of the virus "are unlikely to transmit infection."

The report goes on to say that the decision on whether to use organs in such cases should factor in several variables, including the recipient's risk of death or further complications without immediate transplant. Individual transplant centers make the final decision on which organs to accept for transplant.

Maximizing the supply
Dr. Raquel García-Roca, program director of abdominal transplant and surgical director of renal transplant at Loyola University Medical Center in suburban Chicago, says that hospital began using organs from deceased COVID-positive donors in spring 2022. The medical center is within the Loyola Medicine system, which is part of Trinity Health.


García-Roca and the other transplant doctors at the medical center, in consultation with its infectious disease experts, decided that since there were no documented cases of COVID infection transmission through organ transplants, opportunities to help gravely ill patients were being missed by rejecting these organs. "Because the number of asymptomatic (COVID) infections are so high, we ended up losing a large amount of good organs," she notes.

Through mid-December, García-Roca estimates about 20 liver, kidney and pancreas transplants from COVID-positive donors have been done at Loyola University Medical Center without any cases of infection transmission. Recipients of the organs have fared as well as those whose donors did not test positive for COVID, she says.

"If you ask, 'Is the organ worse because of the COVID?'" García-Roca says, "we haven't seen any difference whatsoever."

The Loyola transplant team's protocols for the use of organs from COVID-positive patients include informing patients when an available organ is from a donor who has tested positive for the virus. Patients choose whether to accept the transplant. After their surgery, recipients are tested for COVID three days after the transplant and again four days later.

Even with the COVID-positive donors added to the pool, García-Roca points out that the need for organs outpaces demand. "We are all trying to optimize and maximize all types of donors," she says of transplant centers. "Even with all the strategies that we do, still, there's a lot of people that are sitting on the waiting list and who actually die waiting for an organ."

The Health Resources & Services Administration, part of the U.S. Department of Health and Human Services, says 17 people die every day in the United States waiting for a transplant.

Neither Loyola nor Baylor St. Luke's is using COVID-positive organs for lung transplants as they await more evidence on the safety of such transplants. In its report, the Ad Hoc Disease Transmission Advisory Committee of the Organ Procurement & Transplantation Network says of COVID-positive lung transplants: "The only confirmed donor-derived transmissions have been through the airway; demonstration of non-airway transmission has not been confirmed at this time."

Experience has benefits
More than a year after its start, Goss says Baylor St. Luke's integration of COVID-positive organs into the hospital's transplant supply continues to go smoothly. Lonnie Dunlap, the recipient of the first COVID-positive transplant at the medical center, is an example of its success. Dunlap passed the first anniversary of his life with a new liver in November.

Before his transplant, Dunlap's health had been slipping since his liver began to fail in 2017. His condition left him bloated and in need of weekly procedures to remove fluid that filled his abdomen. He now sends Goss and others on the team that did his transplant pictures of himself deep sea fishing for yellowfin tuna. "He's doing great," Goss says.

Part of Baylor St. Luke's COVID protocol is to ask all organ recipients to stay up to date on their vaccinations for the virus before transplant. After the surgery, the patients are screened for symptoms of the virus for three weeks.

The doctor points out that, over its long history of organ transplantation, Baylor St. Luke's has adopted protocols to keep organ recipients safe from many viral contagions, including herpes simplex, Epstein-Barr and other coronaviruses.

"That's been a benefit to the entire transplant system, having to work with viruses for years already," Goss says. "It wasn't too much of a stretch to adopt a protocol for COVID patients as well."

Baylor St. Luke's transplant center ranks high in minority recipients

Eric Figueroa, a successful salsa and Latin jazz artist, producer, composer and family man, spent nine years on dialysis because of polycystic kidney disease, a genetic condition that shut down his kidneys.

Eric Figueroa takes a walk shortly after undergoing a kidney transplant at Baylor St. Luke's Medical Center in Houston, part of St. Luke's Health. He had been on dialysis three times a week for years before he got his replacement kidney.

In 2017, he moved from Puerto Rico to Texas in hopes of getting better care. It was at Baylor St. Luke's Medical Center in Houston, part of St. Luke's Health, that doctors told him he was a potential transplant candidate. St. Luke's Health is part of CommonSpirit Health.

The transplant team at Baylor St. Luke's guided Figueroa through the process of getting his name on the national waiting list for a donor kidney. They also worked with him on a nutrition plan that contributed to him losing about 100 pounds, improving his health along with his prospects for a successful transplant.

In April 2022, Figueroa got the call that he says changed his life. It was his transplant team alerting him that a suitable kidney was available. He underwent transplant surgery a day later.

These days, instead of spending the better part of three days each week connected to a dialysis machine and dealing with the resulting exhaustion even longer, the 63-year-old pursues his passions. He's spending quality time with his wife, children and grandchildren. He's also back at his piano, performing, composing and arranging music. Over the course of his musical career, he's contributed to dozens of salsa and Latin jazz albums. He shared a 2002 Latin Grammy for arranging and producing a song on the album that won Best Merengue Album.

"I feel free, away from the machines," Figueroa says. "And that has helped me so much, physically and also definitely mentally."

Tackling disparities head on
National figures show that Black and Hispanic Americans tend to make up a higher percentage of those on organ waiting lists than of those who receive transplants. Dr. John A. Goss, medical director of transplantation at Baylor St. Luke's, says the medical center invests human resources to ensure that Latinos and patients from other minority groups have fair access to transplants. Those efforts have brought results, Goss says.

Four days after the surgery, a jubilant Eric Figueroa prepares to ring the bell that patients sound to celebrate a successful transplant at Baylor St. Luke's. Behind him at left is his wife of 43 years, Wanda Colón.

Based on figures compiled by the Scientific Registry of Transplant Recipients, he says, the medical center outpaces many of the nation's other 250 or so transplant centers in various categories for racial and ethnic minority recipients. For example, more than half of the heart transplants at Baylor St. Luke's transplant center are for patients who are Black, more than double the national rate of 21.6%. Liver transplants for Black and Latino patients at the medical center exceed the national rate by nearly 20%.

Goss says demographics are part of the reason for the higher percentage of transplant recipients from minorities at Baylor St. Luke's. Houston is among the most diverse cities in the nation, with large populations of Latino, Black and Asian residents.

That said, Baylor St. Luke's, Goss says, has been intentional about getting minorities onto national waiting lists for organ donations. The staff assists prospective recipients throughout the evaluations and appointments that are prerequisites to qualifying a patient to get in line for an organ donation, even checking that they have transportation to appointments.

The transplant team — including doctors, nurses, care coordinators, financial counselors and social workers — has people with the language skills and cultural expertise to connect with people of various ethnicities and backgrounds.

To ensure that patients who aren't fluent in English comprehend and correctly complete the necessary forms, staff provide additional direct support.

Goss points out that many prospective transplant patients are daunted just by the enormity of the Texas Medical Center campus, where Baylor St. Luke's is located. On a typical day, 250,000 people are on the campus, which is in the middle of a bustling city.

Non-English speakers and those unfamiliar with the campus may find it frightening and overwhelming to navigate, Goss says. "The schedulers and the coordinators and nurses and everybody have to spend a lot of time trying to get these people in the right spot," he says.

"We try to individualize how we take care of (transplant candidates), so it's not just a cookie cutter thing where people will fall off the list or kind of fall off the radar," he says.

After his transplant surgery, Figueroa made a video about his experience for Baylor St. Luke's YouTube page. In it, he encourages others who might need a transplant to seek out care. "There's nothing scary about the process," he says in the short video. "The outcome will always be better than what you're going through."


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