key: cord-0710569-a4j4b33b authors: Meshram, Hari Shankar; Kute, Vivek B.; Patel, Himanshu; Desai, Sudeep; Chauhan, Sanshriti; Dave, Ruchir B. title: A case report of successful kidney transplantation from a deceased donor with terminal COVID‐19‐related lung damage: Ongoing dilemma between discarding and accepting organs in COVID‐19 era! date: 2021-07-12 journal: Transpl Infect Dis DOI: 10.1111/tid.13683 sha: 323edaaf14f46549808ecebb717afefb50a089cf doc_id: 710569 cord_uid: a4j4b33b para This article is protected by copyright. All rights reserved. with the highest number of COVID-19 cases in the world, and transplantation activity is at halt in many centers. India has a predominantly living donation program where deceased donation is in its incipient stage. 1 has been shown to be associated with higher mortality in transplant patients compared to general population across the world. [2] [3] [4] In the era of COVID-19, the safety of transplantation is an area of evolving research. The authors have reported the safety of donors, and recipients recovered from COVID-19 in living-related transplantation, 5, 6 but there are no such reports of transplantation from deceased donors from Indian subcontinent. Herein, we report our experience of successful deceased donor renal transplantation from a deceased donor with terminal COVID-19-related lung damage. A 44-year-old man with no previous medical history presented with a 3-day history of fever, cough, and difficulty of breathing in the emergency department. He was tested SARS-CoV2 real time polymerase chain test done from nasopharyngeal swab (nRT-PCR) positive and required non-rebreathing mask on admission for maintaining oxygen saturation. His type 1 respiratory failure deteriorated with increasing oxygen requirement, and he required bilevel positive airway pressure on day 4 of admission. As a part of anti-COVID-19 therapy, he received only steroids, and no other immunomodulatory drug was used. He was ultimately put on mechanical ventilation and eventually landed into extracorporeal membrane oxygenation (ECMO). X-ray radiology 4 days before procurement showed bilateral consolidation predominant on the right lung. He was declared brain dead through electro-encephalogram on the 4th day of ECMO and was informed to our transplant center for the possibility of organ donation. The patient was nRT-PCR negative before 11 days of retrieval and documented three consecutive negative nRT-PCR before transplant. The duration from positive nRT-PCR to retrieval day was 24 days. Table 1 Neutrophils (60%-70%) 89 Lymphocytes (25%-33%) 9 Eosinophils (2%-6%) 01 Monocytes (1%-4%) 01 Basophils (0%-1%) 0 patients. 12 To, the best of our knowledge, this is the first Indian report of transplantation from a deceased donor with a history of critical COVID-19. In our report contrary to previous data, 13 induction and other immunosuppressive drugs were given based on the recipient's immune risk stratification and were unchanged in the context of COVID-19. Previously there have been reports of transplantation from a deceased donor who had a history of COVID-19. 14, 15 The prime difference in our report is the fact that COVID-19 was the actual cause of death in our report. Abandoning deceased donor kidney transplantation in will resulted in the wastage of organs and further extension of wait listing in patients. Our findings cannot be applied for organ retrieval of other organs. The decision for not performing preimplantation biopsy was done because of young donor age, normal creatinine, normal urine routine/microscopy, adequate urine output, and no changes in gross examination of the retrieved organs. In a multicenter study from India, 31 recovered live donors were accepted for transplant without any biopsy as none had evidence of hematuria or proteinuria post-COVID-19. 5 In the COVID-19 era, with a rapid shuffling of our understanding of transplantation in COVID-19 positive patients, it is essential to be flexible and intelligent in weighing the risk-benefit ratio of transplantation. Our preliminary report will prove as a learning tool for the transplant communities for grabbing any opportunity for kidney donation in a virologically negative and recovered deceased donor who are admitted with a diagnosis of critical COVID-19. The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported. All the authors have contributed equally to the manuscript. Data are available from the corresponding author upon reasonable request. Hari Shankar Meshram https://orcid.org/0000-0001-9148-8168 Vivek B. Kute https://orcid.org/0000-0001-6549-4505 Himanshu Patel https://orcid.org/0000-0002-8922-0864 Sudeep Desai https://orcid.org/0000-0001-5038-8857 Sanshriti Chauhan https://orcid.org/0000-0001-7385-5614 Ruchir B. Dave https://orcid.org/0000-0003-0569-7188 Deceased-donor organ transplantation in India: current status, challenges, and solutions Clinical profile and outcome of COVID-19 in 250 kidney transplant recipients: a multicenter cohort study from India Inpatient COVID-19 outcomes in solid organ transplant recipients compared to non-solid organ transplant patients: a retrospective cohort COVID-19 in transplant recipients: the Spanish experience Is it safe to be transplanted from living donors who recovered from COVID-19? Experience of 31 kidney transplants in a multicenter cohort study from India A multicenter cohort study from India of 75 kidney transplants in recipients recovered after COVID-19 Utilization of deceased donors during a pandemic: argument against using SARS-CoV-2-positive donors Use of SARS-CoV-2-infected deceased organ donors: should we always "just say no? COVID-19 outcomes in patients waitlisted for kidney transplantation and kidney transplant recipients Organ donation and transplantation during the COVID-19 pandemic: a summary of the Spanish experience Renal transplant guidelines with reference to COVID-19 infection Letter to editor: COVID-19 in kidney transplant recipients vaccinated with Oxford-AstraZeneca COVID-19 vaccine (Covishield): a single center experience from India Early changes in kidney transplant immunosuppression regimens during the COVID-19 pandemic Is kidney transplantation from a COVID-19-positive deceased donor safe for the recipient? Organ recovery from deceased donors with prior COVID-19: a case series A case report of successful kidney transplantation from a deceased donor with terminal COVID-19-related lung damage: Ongoing dilemma between discarding and accepting organs in COVID-19 era!