Heart Transplantation from COVID-19–Positive Donors: A Word of Caution

During the COVID-19 pandemic, efforts to maintain solid-organ transplantation have continued, including the use of SARS-CoV-2–positive heart donors. We present our institution's initial experience with SARS-CoV-2–positive heart donors. All donors met our institution's Transplant Center criteria, including a negative bronchoalveolar lavage polymerase chain reaction result. All but 1 patient received postexposure prophylaxis with anti-spike monoclonal antibody therapy, remdesivir, or both. A total of 6 patients received a heart transplant from a SARS-CoV-2–positive donor. One heart transplant was complicated by catastrophic secondary graft dysfunction requiring venoarterial extracorporeal membrane oxygenation and retransplant. The remaining 5 patients did well postoperatively and were discharged from the hospital. None of the patients had evidence of COVID-19 infection after surgery. Heart transplants from SARS-CoV-2 polymerase chain reaction–positive donors are feasible and safe with adequate screening and postexposure prophylaxis.