Zhang Jared R, Mujtaba Muhammad, Wagenhauser Heidi, Chapman Yvette, Engebretsen Trine, Stevenson Heather L, Hussain Syed, Gamilla-Crudo Ann Kathleen N, Kueht Michael
Department of Surgery, Division of Multiorgan Transplant and Hepatobiliary Surgery, The University of Texas Medical Branch, 301 University Blvd, Galveston TX 77550, USA.
Department of Medicine, Division of Transplant Nephrology, 301 University Blvd, Galveston TX 77550, USA.
Heliyon. 2024 May 31;10(11):e32086. doi: 10.1016/j.heliyon.2024.e32086. eCollection 2024 Jun 15.
Early in the COVID-19 pandemic, positive COVID-19 status often disqualified potential organ donors due to perceived risks, despite limited evidence. Subsequent studies have clarified that the COVID-19 status of donors, particularly when incidental and not the cause of death, does not adversely affect non-lung transplant outcomes. This study quantifies the potential loss of eligible organ donors and the corresponding impact on organ availability during the initial phase of the pandemic.
In this retrospective analysis, we examined deceased donor referrals to a major organ procurement organization from June 2020 to January 2022. Referrals were categorized as All Referrals, Medically Ruled Out (MRO), or Procured Donors (PD). We used Chi-square tests for categorical comparisons and logistic regression to model additional donors and organs, contrasting COVID-negative and positive cases within age-matched cohorts.
Among 9478 referrals, 23.4 % (2221) were COVID-positive. Notably, COVID-positive referrals had a substantially higher MRO rate (80.6 % vs. 29.6 %, p < 0.01) and a markedly lower PD rate (0.2 % vs. 8.2 %, p < 0.01). Potential missed donations of 103 organs from COVID-positive referrals were identified.
This OPO-level study demonstrates a substantial impact of COVID-19 status on organ donation rates, revealing significant missed opportunities. Improved management of donor COVID-19 status could potentially increase organ donations nationwide, taking into account evolving evidence and vaccine availability changes.
在新冠疫情早期，尽管证据有限，但由于存在感知到的风险，新冠病毒检测呈阳性的状态往往会使潜在器官捐献者失去资格。随后的研究表明，捐献者的新冠病毒感染状况，尤其是偶然感染且并非死亡原因时，不会对非肺移植结果产生不利影响。本研究量化了疫情初期合格器官捐献者的潜在损失以及对器官供应的相应影响。
在这项回顾性分析中，我们检查了2020年6月至2022年1月期间一家主要器官采购组织收到的已故捐献者转诊情况。转诊被分为所有转诊、医学排除（MRO）或已获取器官的捐献者（PD）。我们使用卡方检验进行分类比较，并使用逻辑回归对额外的捐献者和器官进行建模，对比年龄匹配队列中的新冠病毒阴性和阳性病例。
在9478例转诊中，23.4%（2221例）新冠病毒检测呈阳性。值得注意的是，新冠病毒检测呈阳性的转诊的医学排除率显著更高（80.6%对29.6%，p<0.01），已获取器官的捐献者率显著更低（0.2%对8.2%，p<0.01）。确定了新冠病毒检测呈阳性的转诊中可能错过的103个器官捐献。
这项器官采购组织层面的研究表明，新冠病毒感染状况对器官捐献率有重大影响，揭示了大量错失的机会。考虑到不断变化的证据和疫苗供应情况的变化，改善对捐献者新冠病毒感染状况的管理可能会在全国范围内增加器官捐献。
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