Covid-19 ravaged Heidi Ferrer’s body and soul for over a year, and in May, the “Dawson’s Creek” screenwriter committed suicide in Los Angeles. She had lost all hope.
“I’m so sorry,” she said in a farewell video to her husband and son. “I would never do that if I was okay.” Try to understand. Please forgive me.”
Her husband, Nick Guthe, writer and director, wanted to donate his body to science. But the hospital said it was not its decision because Ms Ferrer, 50, had signed up to be an organ donor. The specialists therefore recovered several organs of the body before disconnecting it from a ventilator.
Mr Guthe feared that as a result of his wife’s long illness, her organs could not be safely donated to other patients. “I thought they would kill the people to whom they donated these organs,” he said in an interview.
The case highlights an urgent debate among medical professionals over whether the organs of people who have survived Covid, and even those who have died of the disease, are really safe and healthy enough to be transplanted. .
Potential donors are now routinely screened for coronavirus infections before their organs are removed. Generally, organs are considered safe for transplantation if the test is negative, even if the donor has recovered from Covid. But there isn’t a set of universally accepted recommendations about when organs can be safely recovered from virus-positive bodies and transplanted to patients in need.
To complicate the matter, people with long-lasting Covid, whose debilitating symptoms can persist for months, usually do not test positive for the infection. Some researchers fear the virus is still present, hiding in so-called reservoirs inside the body – including some of the very organs donated to transplant patients.
The risk is that surgeons “give the patient Covid, along with the organ,” said Dr Zijian Chen, medical director of the Center for Post-Covid Care at the Mount Sinai Health System. “This is a difficult ethical question. If the patient takes the risk, should we? “
Disease transmission is always a concern during organ transplantation, but there is a huge demand for vital organs in the United States and a limited supply. More than 100,000 people are on waiting lists and 17 people die every day while waiting.
In recent years, the rules for accepting organs from deceased donors who may have infections such as HIV or hepatitis C have been relaxed.
Organ harvesting practices vary considerably from center to center and from region to region, influenced by the local availability of donor organs. There is pressure on supply centers to maintain their numbers, and transplant centers must perform a number of procedures each year to maintain certification.
When Covid started to spread in the United States, the approach to organ recovery was very conservative. But that is about to change.
“When the pandemic started, if you were positive you just weren’t a donor. We didn’t know enough about the disease, ”said Dr. Glen Franklin, medical advisor for the Association of Organ Procurement Organizations.
Today, however, the country’s leading organ transplant organizations have taken different approaches.
Typically, surgeons have avoided transplanting the lungs of patients who have died from Covid because it is a respiratory disease that can cause long-term lung damage.
A woman was infected with the coronavirus last year after receiving the lungs of a donor who tested negative for the virus after a nasal swab, according to a case report published in the American Journal of Transplantation.
A few similar cases have been reported, and now additional tests are being performed on tissue samples taken from the lower respiratory tract of potential lung donors; the transplant only takes place if all tests are negative for the infection.
But other organs can also be affected by the disease. German scientists performed autopsies on the bodies of 27 patients who died from Covid and found the virus in the kidney and heart tissue of more than 60% of those who died. The researchers also found the infection in lung, liver and brain tissue.
Nonetheless, abdominal organs below the diaphragm, such as kidneys or livers, are retrieved for transplantation even if donors are positive for the virus, provided they are asymptomatic, said Dr Franklin of the association. organ supply.
Dr David Klassen, chief medical officer of the United Network for Organ Sharing, which manages the national organ supply network, said decisions have to be made on a case-by-case basis.
“It’s really a risk-benefit calculation,” he said. “A lot of people who are waiting for organs are fatally ill. Their lifespan can be a few days. If they don’t get a transplant, they won’t survive.
Doctors in another group, the American Society of Transplantation, said they would not procure any organs for a patient who showed signs of illness and tested positive for infection.
“If someone has an active Covid and they test positive, we would not buy organs from that donor, none,” said Dr Deepali Kumar, president-elect of the company.
If a deceased donor can have had Covid for a long time and tested negative for Covid, however, the organs would be harvested, said Dr Kumar: “If we start turning down everyone who has had Covid in the past, we would turn down a lot of ‘organs.
A recently updated report, by a committee of the Organ Supply and Transplantation Network, summarized the evidence regarding the recovery of organs from donors with a history of Covid. The authors highlighted the lack of information on long-term outcomes for beneficiaries.
The paper examines the recovery of organs from deceased donors who test positive for coronavirus, deceased donors who survived Covid-19 and tested negative, and living donors who survived Covid.
In all of these cases, according to the report, long-term outcomes for recipients – and living donors, in some cases – are “unknown.”
Transplantation of organs from donors who test positive for the coronavirus “must be done with caution,” the authors warned.
The report also noted that the Delta variant – which now accounts for almost all infections in the United States – is more contagious than previous versions of the virus, and therefore the duration of infectivity “has not been comprehensively assessed. “.
The report makes no mention of long Covid. Doctors specializing in the management of these patients say that although they report a wide range of persistent symptoms, the vast majority appear to have normal functioning organs.
“For people who have suffered target organ damage as a result of Covid, we have ways of detecting this,” said Dr. Jennifer D. Possick, associate professor at the Yale School of Medicine, who runs a long-running clinic recovery center at Yale New Haven Hospital.
But organ function tests aren’t perfect, she warned. “We are as good as our existing tests,” she said. “It’s kind of uncharted territory.”
Dr Chen, of the Mount Sinai Health System, agreed that the organs of long patients with Covid generally function normally during function tests, but said recipients should be made aware of the risks.
One concern is that patients who receive transplanted organs usually need to take drugs that suppress the immune system to prevent organ rejection.
“If they contract Covid, they will be susceptible to infections and poor healing,” Dr Chen said. “I think ethically you have to let the patient know that the risk is real. “
Before she died, Ms Ferrer recounted her ordeal in meticulous notes left on her phone: “Covid Toes” which hurt her feet so much that she could not walk. A tremor that made his body tremble violently. Pain in each limb. Relentless sleeplessness and despair.
Her heart raced. His blood sugar level fluctuated. Worse yet, she couldn’t think properly.
The hospital thought she would be a suitable donor anyway.
“I tried to explain that ‘long haul’ and Covid are not the same things,” said Mr Guthe, her husband. “People catch Covid and get better. It affected every system in his body.
Two Californian men with end-stage kidney disease received his kidneys, he said. No match was found for his other organs. Her liver was severely compromised, as Mr Guthe had warned in hospital, because she had treated herself with high doses of ivermectin, an antiparasitic drug falsely believed to cure long Covid, and an alternative diet that comprised almost two-thirds of a cup. of olive oil every day.
For Mr. Guthe, his son, and other family and friends, the five-day wait until the hospital disconnects Ms. Ferrer from the ventilator was excruciating. Mr Guthe said he promised him he would let people know about the burden of the long Covid.
Now he has another mission.
“Heidi was a very generous person, but she wouldn’t have wanted that,” he said. “We need to create guidelines on what is safe and what is not. “