New Delhi: A 13-year-old girl underwent a successful liver transplant last month at a Delhi hospital, receiving a portion of the vital organ from her sister. What makes her case different from any other liver transplant is that the donor was a recovered Covid patient.
According to doctors at the Max Super Specialty Hospital in Saket, where the transplant took place on 20 May, the girl could possibly be first recipient of liver from a recovered Covid-19 patient.
The donor, who had recovered from Covid-19 three weeks prior to the surgery, is the recipient’s older sister.
The surgery was originally due in March. But two days before the procedure, doctors discovered during the pre-operative routine screening that the older sister was Covid-19 positive but asymptomatic. The diagnosis derailed the plans and put the doctors in a dilemma.
“The child’s condition was such that the surgery couldn’t wait very long, and all other possible donors were ruled out,” said Dr Subhash Gupta, chairman of the Max Centre for Liver & Biliary Sciences who led the surgery.
The girl suffers from Caroli disease, a rare congenital disorder that affects the bile ducts. She had been sick with fever and recurring infections for six months prior to the transplant, which was the last resort after other treatments failed.
The sickness left her “incapacitated,” said Dr Gupta. “We decided the donor needed to be isolated and treated, and we waited for her to turn negative. We waited a full five weeks before proceeding with the transplant,” he said.
The older sister turned negative after three weeks, and the surgery was put off for another two after that, as a precaution. Covid-19 is known to affect all organs, and it’s long-term effects are yet to be determined.
Dr Gupta, however, ruled out the possibility of future complications, saying the donor’s health was checked and that she had fully recovered from Covid-19. In addition to Covid-19 tests, she also underwent a CT scan of the chest to check for any tissue damage, of which she was clear.
“What complicated the procedure further was that they are of different blood groups, so the child’s immunity had to be lowered before the procedure could take place, leaving a very small window of time in which it could be done,” said Dr Gupta. “We had to be extremely careful but the procedure was successful and both are recovering now.”
Both are now recuperating and will stay in the hospital for at least three more days. Dr Gupta said their vitals are being monitored, and the recipient will need to take blood tests on a routine basis for at least one year, until her body adjusts to the new organ.
What leading organisations say on Covid donors
There are cases of organ transplants having been performed on Covid-19 patients and recent organ recipients contracting and recovering from the novel coronavirus. Even though recovered Covid-19 patients are encouraged to donate their blood plasma, there isn’t much information on them becoming organ donors. In fact, there exists no clear protocol for organ donors who have recently recovered from Covid.
“A lot of people are going to test positive for Covid-19, and while active cases should not be allowed to donate, it’s generally agreed upon that it’s safe after 3-4 weeks, given the donor tested negative twice before the procedure,” said Dr. Gupta, who also claims the surgery is the first of its kind. The team of doctors have published their experience of conducting the liver transplant in the American Journal of Transplantation.
They also hope to publish a detailed account of the case in the Liver Transplantation journal.
According to guidelines put out by the National Organ & Tissue Transplant Organisation (NOTTO), “Living donor with positive Covid-19 test should not donate for at least 3-6 months until the long-term outcome of cured Covid-19 becomes clear.”
The guidelines, however add, “In case of life-saving transplants, we suggest accepting donors with a previous diagnosis of Covid-19 with documented two negative Covid-19 tests and complete symptom resolution for 28 days and another negative test at the time of donation.”
Some of the leading transplant organisations in the world advise doctors to exercise their discretion when accepting Covid-19 survivors as organ donors.
The American Society of Transplantation says living donors who test positive for Covid-19 “should have donations postponed until they are at least 28 days beyond symptom resolution and have a negative SARS-CoV-2 PCR test”. Deceased owners whose symptoms had resolved 28 or more days prior to procurement, and who have tested negative, are “likely to be safe”.