- It was performed by a multidisciplinary team of specialists from UMAE No. 25, in Nuevo León, on a minor who had a prognosis of up to 72 hours to live.
- The organ was donated by a 16-year-old boy and procured in Irapuato, Guanajuato.
- The fact marks a milestone in the entire country, as it is the first transplant of an organ donated by a patient with a positive test for SARS-CoV-2.
Medical specialists from the Mexican Institute of Social Security (IMSS) carried out the first transplant nationwide from a COVID-19 positive donor. This historic event occurred in the High Specialty Medical Unit (UMAE) No. 25, in Nuevo León. While the action served to save the life of a 12-year-old girl, whose life expectancy did not exceed 72 hours if she did not receive a new liver.
Description of the medical case
Two hours after “Code 0” was decreed, classified as a “National Emergency”, by the National Transplant Center (Cenatra), a life expectancy appeared for Sofía, 12 years old. However, there was an obstacle: the donor had tested positive for COVID-19.
UMAE No. 25 was facing a new challenge: the multidisciplinary team of specialists analyzed the international protocol to determine the feasibility of placing in the girl an organ donated by a patient with brain death, but with a positive test for SARS-CoV-2.
The head of the hospital’s Transplant Division, Dr. Gerardo Luna López, explained that little Sofía suffered from Alagille syndrome. It is a rare hereditary disease that causes multiple conditions, mainly to the liver, where cirrhosis occurs, which leads to liver failure.
In addition, on March 27 of this year, the minor had received a first liver transplant in this same hospital. The problem was that on the fifth day after surgery she presented a complication due to hepatic artery thrombosis. Due to the above, she required a surgical intervention to reconstruct the vessel, which was unsuccessful.
From then on, death for Sofia seemed imminent. On April 4, the case was raised as a national emergency for a transplant with the next liver donation from any place or institution in the country.
Two hours later, in Irapuato, Guanajuato, the donation of the organ by a 16-year-old male patient was reported. It was the opportunity that the doctors were waiting for the patient Sofía.
In the donor’s examinations, a positive diagnosis to COVID-19but the characteristics of weight, height and even blood group were compatible with the recipient.
“We knew that we were not going to find another opportunity like this,” commented Dr. Luna López, indicating that the patient was expected to have a maximum of 72 hours to live.
All check-ups necessary for the transplant
The transplant committee of UMAE No. 25 focused on analyzing the cost-benefit of said transplant. Although he was positive for COVID-19, the donor had been asymptomatic, his viral load was not highly contagious, and his death was for a different reason: a serious neurological injury.
The doctors reinforced the viability of the transplant by offering the patient a prophylactic treatment available to the hospital to protect her from viral infection.
With these arguments in favor, the prosecutorial team went to the General Hospital (HG) of Irapuato, of the Health Secretary (SSa), wearing Personal Protection Equipment to extract the organ and bring it to Nuevo León. There the transplant surgeons worked for six hours to place the liver in the minor who was already waiting for him to continue living.
The head of the Transplant Division of the Specialty Hospital No. 25 explained that liver transplantation is a highly complex surgical process. This is because there are four structures that must be connected to the recipient’s body: the hepatic artery, the portal vein, the suprahepatic veins and the bile duct, all of them with millimeter calibers that require extreme precision to fit and function properly.
In the end, the surgery was a success because it left no evidence of viral infection in the recipient or in the surgeons, and it set a precedent in the history of IMSS throughout the country.
“This will set a trend for medical science. Now we know that it is possible to investigate and make the best decision in this type of case so as not to waste organs donated by asymptomatic patients with COVID-19.”
The critical 72 hours were spent in intensive care and, on April 21, the patient returned home with a good prognosis for life, to carry out her routine activities normally.
For Dr. José Manuel Pavón Sánchez, a Pediatric Intensive Care physician, the coordination of all the medical disciplines that interact in this type of case was very important.
“I feel very proud to be part of the institution, of this great health team. Knowing that we have great support from our bosses, from our directors. I am proud to know that through my work, we were able to change Sofia’s life. This, for one as a professional, is very encouraging, it is gasoline to continue doing things better and better”.
For his part, the general director of UMAE No. 25, Dr. José María Sepúlveda Núñez, assured that these are the results of the work of all categories of the hospital that assume the challenges that are necessary in the care process.
“As director of this hospital, it is a great honor and pride for me to have a great work team. The first transplant to be performed with a liver from a patient with a positive COVID-19 test was a great challenge that a great team took on and, fortunately, it was successful.”
He confirmed that Sofía was discharged and, both he and the entire medical team that participated in the intervention, hope that she will continue to evolve positively. Meanwhile, the medical team has already made history by completing the first transplant from a donor with Covid-19.