Transplantation of organs from SARS-CoV-2-positive donors: Preliminary experience from Spain

BACKGROUND

The utilization of non-lung organs from deceased donors with a positive polymerase chain reaction (PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the time of donation can be lifesaving, although the safety of this policy must be assessed.

METHODS

This is a nationwide, prospective study, reporting the experience on the utilization of non-lung organs from SARS-CoV-2-positive donors between December 15, 2020 and May 31, 2022 in Spain.

RESULTS

A total of 69 patients received a solid organ transplant (41 kidney, 18 liver, 8 heart, and 2 combined liver-kidney) obtained from 32 donors with a positive SARS-CoV-2 PCR at the time of donation (four of them with a cycle threshold value <30). All recipients tested negative for SARS-CoV-2 and were free of coronavirus disease 2019 (COVID-19) symptoms prior to transplantation. Nasopharyngeal swab turned positive for SARS-CoV-2 PCR in 4 (5.8%) recipients at 3, 8, 11, and 20 days after transplantation, though evidence did not support a donor-derived COVID-19. Four kidney recipients lost their grafts and two patients died: one heart recipient due to cardiogenic shock and one combined liver-kidney recipient due to lung hypertension and right heart failure. Graft losses and patient deaths were deemed unrelated to the donor SARS-CoV-2 status by the treating teams. No other adverse reactions were reported.

CONCLUSIONS

This preliminary experience supports the safety of the use of organs other than lungs from SARS-CoV-2 PCR-positive donors, in alignment with previous series. However, the impact of SARS-CoV-2 infection upon organ quality should be established in future research.

[Economics and equity in urgency and emergency care]

The financial sustainability of public health systems (PHS) is currently threatened by population growth, increased prevalence of chronic conditions and disabilities, inequality in access and use of resources, zero cost delivery and global economic crisis. The emergency department (ED) is one for which demand is highest--without relation to the health model--because disease becomes established in disadvantaged socio-demographic areas and inequalities, hyperconsumption and decision making more closely linked to the user are maintained. The medical device of ED is a multiple one and its diverse product lines make it difficult to measure. This review discusses the need to deploy measurement tools in ED, where there are high direct costs--primarily structural--and other variables related to the activity, where the marginal cost is higher than the average and there is no economy of scale in such interventions. The possible mechanisms of private copayment in financing the supply of EDs are also studied, showing their advantages and disadvantages, with the conclusion that they are not recommendable--due to their scarce fund raising and deterrent capacity, which is why fundamental strategic changes in the management of these resources are needed.

Thrombosed mechanical pulmonary valve successfully treated with thrombolysis

Prosthetic heart valve thrombosis is a serious complication with a high mortality. We report the case of a thrombosed St Jude Medical valve placed in the pulmonary position, in a patient who had undergone repair of tetralogy of Fallot, which was successfully treated with intravenous thrombolytic therapy with streptokinase.

[Permanent His-bundle pacing in patients with infra-Hisian atrioventricular block]

INTRODUCTION AND OBJECTIVES

Permanent His-bundle pacing is effective in patients with supra-Hisian atrioventricular block. We report our experience in patients with infra-Hisian atrioventricular block.

METHODS

The study involved selected patients referred for syncope and intraventricular conduction disturbance, infra-Hisian atrioventricular block, with left ventricular dyssynchrony and no coronary sinus access. All patients underwent electrophysiological study to evaluate infra-Hisian atrioventricular conduction, both at baseline and after flecainide administration. We selected patients with an indication for permanent pacing in whom His-bundle pacing produced a narrow QRS complex. Leads were implanted in the right atrium, in the bundle of His, and at the apex of the right ventricle, and connected to the atrial, left ventricular, and right ventricular terminals, respectively, of a biventricular pacemaker generator. All pacemakers were programmed in DDD mode with a left ventricle-right ventricle interval of 80 ms.

RESULTS

Between February and December 2004, seven patients met the study's inclusion criteria. The His-bundle lead was implanted successfully in five. The His-bundle pacing threshold remained stable in two patients, whereas it increased in three. During follow-up, at between 2 and 12 months, no lead dislodgement or failure to capture was observed. Echocardiography did not disclose any deterioration in ventricular function, or any worsening of or new valvular incompetence, but showed that ventricular dyssynchrony had disappeared in previously affected patients.

CONCLUSIONS

His-bundle pacing is the only pacing mode capable of inducing a physiologically normal ventricular contraction. It can be used in some patients with infra-Hisian atrioventricular block.