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Covid-19 devastated Heidi Ferrer’s body and soul for more than a year, and in May the screenwriter of “Dawson’s Creek” committed suicide in Los Angeles. He had lost all hope.

“I’m so sorry,” she said in a farewell video to her husband and son. “I would never have done this if I was fine. Please understand. Forgive me please.”

Her husband, writer and director, Nick Guthe, wanted to donate her body to science. However, the hospital said it had not made that decision because Ms Ferrer, 50, had signed up to become an organ donor. Thus, experts recovered several organs from his body before weaning him off the ventilator.

Mr. Guthe worries that after his wife’s prolonged illness, it may not be safe to donate his organs to other patients. “I thought they were going to kill the people they gave these organs to,” he said in an interview.

The case highlights an urgent debate among medical professionals about whether the organs of people who have recovered from Covid or even those who have died from the disease are safe and healthy enough to be transplanted.

Potential donors are now routinely screened for coronavirus infections before their organs are removed. In general, organs are considered safe for transplant if the test is negative, even if the donor has survived Covid. However, there is no universally accepted set of recommendations for when organs can be safely recovered from virus-positive bodies and transplanted into patients who need them.

What complicates the question is that people with long-term Covid, whose debilitating symptoms can last for months, often do not test positive for the infection. Some researchers fear that the virus may be present by hiding in so-called reservoirs in the body, including some of the organs given to transplant patients.

The medical director of the Center for Post-Covid Care at Mount Sinai Health System, Dr. Zijian Chen said the risk is that surgeons can “give Covid to the patient with the organ.” “It’s a difficult ethical question. If the patient is taking the risk, should we do it?”

Disease transmission is always a concern when organs are transplanted, but there is tremendous demand and limited supply for life-saving organs in the United States. More than 100,000 people are on the waiting list and 17 die waiting every day.

In recent years, rules for accepting organs from deceased donors who may have infections such as HIV or hepatitis C have been relaxed.

Organ salvage practices vary widely from one center and region to another, influenced by the local availability of donor organs. There is pressure on supply centers to keep their numbers high, and transplant centers must perform a certain number of procedures each year to maintain certification.

When Covid first began to spread in the United States, the approach to organ saving was very conservative. But this is changing.

“If you were positive at the beginning of the pandemic, you wouldn’t be a donor. “We didn’t know enough about the disease,” he said. Medical adviser to the Association of Organ Procurement Organizations, Dr. Glen Franklin.

Now, however, the country’s leading transplant organizations have taken different approaches.

Generally, surgeons have avoided transplanting the lungs of patients who have died from Covid, as it is a respiratory disease that can cause long-term lung damage.

Last year, a woman became infected with the coronavirus after taking the lungs of a donor who tested negative for the virus after a nose swab. a published case report in the American Journal of Transplantation.

Several similar cases have been reported and additional testing is now being done on tissue samples from the lower airways of potential lung donors; transplant will only proceed if all tests are negative for infection.

But other organs can also be affected by the disease. Scientists took the stage in Germany Autopsy was performed on the bodies of 27 patients. Those who died of Covid and found the virus in the kidney and heart tissues of more than 60 percent of the deceased. Researchers also found the infection in lung, liver, and brain tissue.

However, from the organ supply association Dr. The abdominal organs below the diaphragm, such as kidneys or livers, are saved for transplantation as long as they are asymptomatic, even if the donors test positive for the virus, Franklin said.

The chief medical officer of the United Network for Organ Sharing, which manages the country’s organ supply network, Dr. David Klassen said that decisions should be made “on a case-by-case basis”.

“It’s really a risk-benefit calculation,” he said. “Many people waiting for organs are terminally ill. Their lifespan can be reduced to a few days. He cannot survive without the transplant.

Doctors from another group, the American Society of Transplantation, said they would not take organs from any patient who showed signs of illness and tested positive for infection.

The elected president of the association, Dr. Deepali Kumar said, “If someone has active Covid and they test positive, we will not take organs from that donor, not at all.”

If a deceased donor had had Covid for a long time and the Covid test was negative, their organs would have been removed, Dr. Kumar said: “It’s a lot of organs if we start turning away everyone who has had Covid in the past.”

A last updated reportsummarized the evidence on organ recovery from donors with a history of Covid-19 by the Organ Procurement and Transplant Network committee. The authors highlighted the lack of information about long-term outcomes for buyers.

The document examines organ recovery from deceased donors who test positive for coronavirus, deceased donors who have recovered from Covid-19 and tested negative, and living donors who have survived Covid.

In all these cases, the long-term consequences for recipients and, in some cases, living donors, are “unknown,” the report said.

The authors cautioned that organ transplants from donors who test positive for coronavirus “must proceed with caution.”

The report also noted that the Delta variant, which currently accounts for nearly all infections in the United States, is more contagious than previous versions of the virus, so the duration of contagion has not been “extensively evaluated”.

The report makes no mention of prolonged Covid. Doctors specializing in the care of these patients say that although they report a wide variety of persistent symptoms, the vast majority appear to have normally functioning organs.

An associate professor at Yale School of Medicine and running a long-standing Covid recovery clinic, Dr. “For people with end-organ damage due to Covid, we have ways to detect it,” said Jennifer D. Possick. Yale New Haven Hospital.

But organ function tests aren’t perfect, he warned. “We are only as good as our current tests,” he said. “It’s kind of uncharted territory.”

From Mount Sinai Health System, Dr. Chen acknowledged that organs from long-term Covid patients usually perform normally on function tests, but said recipients should be informed about the risks.

One concern is that patients who receive transplanted organs often need to take immunosuppressant drugs to prevent organ rejection.

Dr. “If they get Covid, they will be susceptible to infections and poor recovery,” Chen said. “I think, ethically, you need to let the patient know that the risk is very real.”

Before she died, Ms. Ferrer recorded her ordeal in meticulous notes on her phone: “Covid toes” that made her feet too sore to walk. A tremor that violently shook his body. Pain in every limb. Brutal insomnia and despair.

His heart quickened. Blood sugar levels fluctuated. Worst of all, he couldn’t think straight.

The hospital already thought he would be a suitable donor.

“I tried to explain that ‘long distance’ and Covid are not the same things,” said her husband, Mr Guthe. “People get Covid and get better. It affected every system in his body.”

He said he had kidneys removed from two California men with end-stage kidney disease. No matches were found for the other organs. His liver was in serious jeopardy, as Mr. Guthe had warned the hospital, as he was treating himself with an alternative diet containing large doses of ivermectin, an antiparasitic drug said to cure long-term Covid, and about two-thirds of a cup. Olive oil every day.

For Mr. Guthe, his son, and other family members and friends, the five-day period until the hospital disconnected Ms. Ferrer from her ventilator was unbearable. Mr Guthe said he promised to educate people about the long-term burden of Covid.

Now he has another task.

“Heidi was a very giving person, but she wouldn’t want that,” she said. “We need to create guidelines on what is safe and what is not.”