The following is a brief summary of surveyed guidance from publicly available recommendations from organ donation and transplantation groups compiled in partnership with Canadian Blood Services (CBS), Canadian Society of Transplantation (CST) and Canadian Donation and Transplantation Research Program (CDTRP). These vary from international societies such as The Transplantation Society to national bodies. The summaries will be updated regularly as new and revised recommendations become available.
This is not meant to be a comprehensive sample of all groups who have made COVID-19 related recommendations. The first group of documents analyzed were those that had been collated on The Transplantation Society website at the time of review. Further revisions of these summaries will include documents and recommendations from other groups as they become available and based on feedback from the ODT community.
The statements summarized below are expert opinions and/or consensus-based statements/recommendations published by various individuals or societies, internationally. Preliminary statements related to transplantation in the setting of COVID-19 were systematically searched. The summarized statements may not necessarily be based on empirical evidence, nor considering patient’s values and preferences. Please note that none of these are meant to serve as official guideline recommendations for healthcare providers and decision makers endorsed by the Canadian Donation and Transplantation Research Program or Canadian Blood Services.
The final update for this project was on April 30, 2021. No other updates will be available past this date.
While we recognize the distinction between the viral pathogen SARS-CoV-2 and COVID-19, the illness caused by the virus, in the interest of simplicity and readability, we will refer primarily to COVID-19. For example, when screening potential donors, we will state that we are screening for COVID-19, understanding that the tests are designed to detect evidence of SARS-CoV-2.
Abbreviated terminology used: Y (Yes, to indicate recommendations) / N (No, to indicate not recommended) / NR (No recommendation, to indicate no recommendation offered from institution). Click on underlined letters to view recommendations.
Project Leads: Matthew Weiss, Allison Mah. Special thank you: Laura Hornby, Chelsea Patriquin, Jehan Lalani, Fatima Dharsee, Christina Parsons, Kyle Maru, Daniela Massierer, Minal Borkar-Tipathi, Lauren Westhaver, Christine Wardell, Mackenzie Cullip, Alissa Rutman, Shanshan Lan and Hyunyun Kim.
Last update: April 30, 2021
COVID-19 Screening of Potential Deceased Donors
Testing and Screening for All Patients who are Potential Donors?
There was broad agreement that all patients who are potential deceased donors should undergo some form of COVID-19 testing or screening.
Region | Institution | Recommend Screening for all Potential Donors? | Recommend screening for respiratory infection symptoms or epidemiologic factors regardless of testing result? | Website/Source of Information |
---|---|---|---|---|
International | The International Society of Heart and Lung Transplantation | Y | Y | https://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf |
International Liver Transplant Society | NR | NR | https://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/ | |
The Transplantation Society | Y | NR | https://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140 | |
Asia | Indian Society of Transplantation | Y | NR | https://isot.co.in/file/ISOT_COVID_V1_March_26.pdf |
Korean Society for Transplantation | Y | NR | http://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword= | |
Australasia | Australian Government Organ and Tissue Authority and The Transplantation Society of Australia and New Zealand | Y | Y | https://www.tsanz.com.au/ |
Europe | European Centre for Disease Prevention and Control | Y | NR | https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf |
European Society of Transplantation | N | Y | https://tts.org/tid-about/tid-presidents-message/23-tid/tid-news/657-tid-update-and-guidance-on-2019-novel-coronavirus-2019-ncov-for-transplant-id-clinicians | |
Agence de la Biomédecine | Y | NR | https://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf | |
Belgian Transplantation Society | Y | NR | https://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf | |
Dutch Transplantation Foundation | Y | NR | https://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie | |
Organización Nacional de Trasplantes | Y | Y | https://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf | |
NHS Blood and Transplant | Y | NR | https://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/ | |
Swisstransplant | Y | Y | English fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf | |
Latin America | Brazilian Association of Organ Transplantation | NR | NR | http://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157 |
North America | American Association For The Study Of Liver Diseases | Y | Y | https://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf |
American Society of Transplant Surgeons | Y | NR | https://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl | |
Canadian Blood Services and Canadian Society of Transplantation | Y | NR | https://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services | |
Organ Procurement and Transplantation Network | NR | NR | TTS.ORG - pdf Information for transplant programs | |
United Network for Organ Sharing/American Society for Transplantation | NR | NR | https://www.myast.org/covid-19-information https://unos.org/covid/ |
Nasopharyngeal and Oropharyngeal Swab (Polymerase Chain Reaction) PCR Testing (columns 1 and 2)
Nasopharyngeal (NP) PCR swab was the preferred testing modality of most organizations. In most areas, this is the most routinely performed test and likely the most readily available. Concerns over sensitivity, especially early reports of high rates of false negatives, caused certain groups to recommend other screening in addition to NP swabs, but no group recommended against its use.
Oropharyngeal (OP) PCR swabs were also frequently recommended by groups, often as an alternative to NP swabs. Most groups did not distinguish between NP or OP swabs.
Preferential use of bronchial secretion for PCR Testing (column 3)
Some groups recommend bronchial secretion testing due to suspected increased sensitivity, though with caveats. The first is that collecting sample through bronchoalveolar lavage (BAL) sampling increases the risk of aerosol generation and thus spread of virus if present. Several groups cautioned that if BAL is chosen, it must be done according to local infection guidelines to limit aerosol generation and spread. Alternatively, bronchial secretions could be collected using techniques such as wedged in-line suction that would decrease or eliminate the risk of aerosolization. No organization cited evidence to suggest that one of these methods to collect bronchial secretions has proven improved sensitivity or specificity.
Thoracic computerized tomography (CT) scans in asymptomatic potential donors (column 5)
Most groups made no recommendation regarding the use of CT scan in asymptomatic patients. One group suggests CT scans have the potential to discover radiologic evidence of COVID-19 prior to symptom development in this population. Other organizations recommended against this type of screening. No group cited evidence to suggest that this application of CT screening was effective in diagnosing COVID-19 in patients with negative PCR testing.
Use of blood testing (column 6)
No group recommends the current use of blood work (antibody or serology testing) for clinical decision making.
Region | Institution | 1. Recommend Nasopharyngeal Swab PCR Testing | 2. Recommend Oropharyngeal Swab PCR Testing | 3. Recommend Preferential use of Bronchial Secretion for PCR Testing | 4. Recommend enhanced testing or procedures for at risk potential donors (e.g. travel history or symptoms)? | 5.Recommendation thoracic CT scan in asymptomatic potential donors? | 6. Recommend use of blood testing when available? | Website/Source of Information |
---|---|---|---|---|---|---|---|---|
International | The International Society of Heart and Lung Transplantation | Y | Y | Y | Y | Y | NR | https://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf |
International Liver Transplant Society | NR | NR | NR | NR | NR | NR | https://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/ | |
The Transplantation Society | NR | NR | NR | Y | NR | NR | https://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140 | |
Asia | Indian Society of Transplantation | NR | NR | NR | Y | NR | NR | https://isot.co.in/file/ISOT_COVID_V1_March_26.pdf |
Korean Society for Transplantation | NR | NR | NR | Y | NR | NR | http://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword= | |
Australasia | Australian Government Organ and Tissue Authority and The Transplantation Society of Australia and New Zealand | Y | Y | Y | Y | NR | N | https://www.tsanz.com.au/ |
Europe | European Centre for Disease Prevention and Control | Y | NR | NR | Y | NR | NR | https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf |
European Society of Transplantation | Y | Y | Y | Y | NR | NR | https://tts.org/tid-about/tid-presidents-message/23-tid/tid-news/657-tid-update-and-guidance-on-2019-novel-coronavirus-2019-ncov-for-transplant-id-clinicians | |
Agence de la Biomédecine | Y | NR | N | NR | NR | Y | https://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf | |
Belgian Transplantation Society | Y | NR | N | N | Y | NR | https://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf | |
Dutch Transplantation Foundation | NR | Y | NR | NR | NR | NR | https://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie | |
Organización Nacional de Trasplantes | Y | Y | Y | NR | N | N | https://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf | |
NHS Blood and Transplant | Y | Y | Y | NR | NR | NR | https://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/ | |
Swisstransplant | Y | NR | Y | N | N | NR | English fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf | |
Latin America | Brazilian Association of Organ Transplantation | NR | NR | NR | NR | NR | NR | http://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157 |
North America | American Association For The Study Of Liver Diseases | Y | Y | Y | Y | NR | N | https://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf |
American Society of Transplant Surgeons | NR | NR | NR | Y | NR | N | https://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl | |
Canadian Blood Services and Canadian Society of Transplantation | Y | Y | Y | Y | N | Y | https://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services | |
Organ Procurement and Transplantation Network | NR | NR | NR | NR | NR | NR | TTS.ORG- pdf Information for transplant programs | |
United Network for Organ Sharing/American Society for Transplantation | NR | NR | NR | NR | NR | NR | https://www.myast.org/covid-19-information https://unos.org/covid/ |
Excluding donors with documented COVID-19 infection? (column 1)
At the time of this survey of recommendations, all groups explicitly or implicitly excluded donation from COVID-19 positive donors, except the United Network for Organ Sharing/American Society for Transplantation. The United Network for Organ Sharing/American Society for Transplantation offer considerations for proceeding in light of a positive test from a previously infected patient if: 1) the patient is between 21 – 90 days from initial symptoms 2) symptoms have resolved and 3) an infectious disease expert is consulted. This statement acknowledges that positive PCR tests in time-frame from asymptomatic patients most likely represents persistent viral shedding of little significance, rather than active infection. They recommend that any recipient of an organ from this class of donor would require enhanced follow-up due to the unknown infection risk.
Excluding donors with inconclusive COVID-19 screening? (column 2)
Several screened organizations included a comment that patients with inconclusive testing should be excluded as potential donors in certain circumstances, while others suggest these cases may be considered on a case-by-case basis.
Region | Institution | 1. Recommend excluding donors with documented COVID-19 infection? | 2. Recommend excluding donors with inconclusive COVID-19 screening? | Website/Source of Information |
---|---|---|---|---|
International | The International Society of Heart and Lung Transplantation | Y | NR | https://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf |
International Liver Transplant Society | NR | NR | https://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/ | |
The Transplantation Society | Y | Y | https://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140 | |
Asia | Indian Society of Transplantation | Y | NR | https://isot.co.in/file/ISOT_COVID_V1_March_26.pdf |
Korean Society for Transplantation | NR | NR | http://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword= | |
Australasia | Australian Government Organ and Tissue Authority and The Transplantation Society of Australia and New Zealand | Y | Y | https://www.tsanz.com.au/ |
Europe | European Centre for Disease Prevention and Control | Y | NR | https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf |
European Society of Transplantation | NR | NR | https://tts.org/tid-about/tid-presidents-message/23-tid/tid-news/657-tid-update-and-guidance-on-2019-novel-coronavirus-2019-ncov-for-transplant-id-clinicians | |
Agence de la Biomédecine | N | NR | https://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf | |
Belgian Transplantation Society | Y | NR | https://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf | |
Dutch Transplantation Foundation | Y | NR | https://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie | |
Organización Nacional de Trasplantes | Y | Y | https://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf | |
NHS Blood and Transplant | Y | Y | https://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/ | |
Swisstransplant | Y | Y | English fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf | |
Latin America | Brazilian Association of Organ Transplantation | NR | NR | http://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157 |
North America | American Association For The Study Of Liver Diseases | Y | NR | https://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf |
American Society of Transplant Surgeons | Y | NR | https://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl | |
Canadian Blood Services and Canadian Society of Transplantation | Y | N | https://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services | |
Organ Procurement and Transplantation Network | NR | NR | TTS.ORG - pdf Information for transplant programs | |
United Network for Organ Sharing/American Society for Transplantation | NR | NR | https://www.myast.org/covid-19-information https://unos.org/covid/ |
While most groups recommended laboratory screening of patients who are potential donors as detailed above, some also recommended that patients should be excluded based on certain clinical or exposure risk criteria regardless of laboratory findings. For example, the Australian/New Zealand joint recommendation states: “patients with severe bilateral community acquired pneumonia should be excluded regardless of screening results.”
Region | Institution | Recommendation regarding exclusion of potential donors based on clinical criteria? | Website/Source of Information |
---|---|---|---|
International | The International Society of Heart and Lung Transplantation | Y | https://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf |
International Liver Transplant Society | NR | https://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/ | |
The Transplantation Society | Y | https://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140 | |
Asia | Indian Society of Transplantation | Y | https://isot.co.in/file/ISOT_COVID_V1_March_26.pdf |
Korean Society for Transplantation | NR | http://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword= | |
Australasia | Australian Government Organ and Tissue Authority and The Transplantation Society of Australia and New Zealand | Y | https://www.tsanz.com.au/ |
Europe | European Centre for Disease Prevention and Control | NR | https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf |
European Society of Transplantation | Y | https://tts.org/tid-about/tid-presidents-message/23-tid/tid-news/657-tid-update-and-guidance-on-2019-novel-coronavirus-2019-ncov-for-transplant-id-clinicians | |
Agence de la Biomédecine | N | https://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf | |
Belgian Transplantation Society | NR | https://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf | |
Dutch Transplantation Foundation | Y | https://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie | |
Organización Nacional de Trasplantes | Y | https://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf | |
NHS Blood and Transplant | N | https://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/ | |
Swisstransplant | Y | English fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf | |
Latin America | Brazilian Association of Organ Transplantation | NR | http://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157 |
North America | American Association For The Study Of Liver Diseases | Y | https://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf |
American Society of Transplant Surgeons | NR | https://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl | |
Canadian Blood Services and Canadian Society of Transplantation | Y | https://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services | |
Organ Procurement and Transplantation Network | Y | TTS.ORG - pdf Information for transplant programs | |
United Network for Organ Sharing/American Society for Transplantation | NR | https://www.myast.org/covid-19-information https://unos.org/covid/ |
Four groups commented on acceptance of organs from other countries. No group categorically excluded acceptance of international offers. They instead stated that these offers should be considered based on the epidemiology of the offering location in consultation with the organ donation organization (ODO) medical direction.
Region | Institution | Recommendation regarding organs offered from other countries? | Website/Source of Information |
---|---|---|---|
International | The International Society of Heart and Lung Transplantation | NR | https://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf |
International Liver Transplant Society | NR | https://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/ | |
The Transplantation Society | Y | https://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140 | |
Asia | Indian Society of Transplantation | NR | https://isot.co.in/file/ISOT_COVID_V1_March_26.pdf |
Korean Society for Transplantation | NR | http://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword= | |
Australasia | Australian Government Organ and Tissue Authority and The Transplantation Society of Australia and New Zealand | NR | https://www.tsanz.com.au/ |
Europe | European Centre for Disease Prevention and Control | NR | https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf |
European Society of Transplantation | NR | https://tts.org/tid-about/tid-presidents-message/23-tid/tid-news/657-tid-update-and-guidance-on-2019-novel-coronavirus-2019-ncov-for-transplant-id-clinicians | |
Agence de la Biomédecine | NR | https://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf | |
Belgian Transplantation Society | Y | https://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf | |
Dutch Transplantation Foundation | Y | https://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie | |
Organización Nacional de Trasplantes | NR | https://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf | |
NHS Blood and Transplant | NR | https://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/ | |
Swisstransplant | N | English fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf | |
Latin America | Brazilian Association of Organ Transplantation | NR | http://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157 |
North America | American Association For The Study Of Liver Diseases | NR | https://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf |
American Society of Transplant Surgeons | NR | https://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl | |
Canadian Blood Services and Canadian Society of Transplantation | Y | https://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services | |
Organ Procurement and Transplantation Network | NR | TTS.ORG - pdf Information for transplant programs | |
United Network for Organ Sharing/American Society for Transplantation | NR | https://www.myast.org/covid-19-information https://unos.org/covid/ |
While several groups recommended protocols or algorithms to determine when a patient with previously confirmed COVID-19 could be considered a potential donor, there was substantial variability in the details of those algorithms. Waiting periods after resolution of symptoms varied from 14 to 28 days. Most, but not all, groups specifically recommended repeat testing after symptom resolution, with some requiring a single negative test and others two tests. Clarification in this area will become increasingly important as the incidence of COVID-19 increases and more patients with a recent history of COVID-19 become potential donors due to unrelated illness or injuries.
Region | Institution | Recommend testing regimen for documenting clearance of confirmed cases? | Website/Source of Information |
---|---|---|---|
International | The International Society of Heart and Lung Transplantation | Y | https://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf |
International Liver Transplant Society | NR | https://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/ | |
The Transplantation Society | NR | https://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140 | |
Asia | Indian Society of Transplantation | NR | https://isot.co.in/file/ISOT_COVID_V1_March_26.pdf |
Korean Society for Transplantation | NR | http://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword= | |
Australasia | Australian Government Organ and Tissue Authority and The Transplantation Society of Australia and New Zealand | Y | https://www.tsanz.com.au/ |
Europe | European Centre for Disease Prevention and Control | Y | https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf |
European Society of Transplantation | N | https://tts.org/tid-about/tid-presidents-message/23-tid/tid-news/657-tid-update-and-guidance-on-2019-novel-coronavirus-2019-ncov-for-transplant-id-clinicians | |
Agence de la Biomédecine | NR | https://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf | |
Belgian Transplantation Society | N | https://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf | |
Dutch Transplantation Foundation | NR | https://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie | |
Organización Nacional de Trasplantes | Y | https://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf | |
NHS Blood and Transplant | Y | https://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/ | |
Swisstransplant | Y | English fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf | |
Latin America | Brazilian Association of Organ Transplantation | NR | http://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157 |
North America | American Association For The Study Of Liver Diseases | Y | https://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf |
American Society of Transplant Surgeons | Y | https://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl | |
Canadian Blood Services and Canadian Society of Transplantation | Y | https://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services | |
Organ Procurement and Transplantation Network | NR | TTS.ORG - pdf Information for transplant programs | |
United Network for Organ Sharing/American Society for Transplantation | Y | https://www.myast.org/covid-19-information https://unos.org/covid/ |
The International Liver Transplantation Society (Feb. 2020), specifically recommended avoiding recovery from donors within endemic or high prevalence areas. Several other organizations surveyed suggested this recommendation be considered.
Region | Institution | Recommend avoiding retrieval from donors within endemic/high prevalence areas | Website/Source of Information |
---|---|---|---|
International | The International Society of Heart and Lung Transplantation | NR | https://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf |
International Liver Transplant Society | Y | https://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/ | |
The Transplantation Society | Y | https://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140 | |
Asia | Indian Society of Transplantation | NR | https://isot.co.in/file/ISOT_COVID_V1_March_26.pdf |
Korean Society for Transplantation | NR | http://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword= | |
Australasia | Australian Government Organ and Tissue Authority and The Transplantation Society of Australia and New Zealand | NR | https://www.tsanz.com.au/ |
Europe | European Centre for Disease Prevention and Control | NR | https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf |
European Society of Transplantation | Y | https://tts.org/tid-about/tid-presidents-message/23-tid/tid-news/657-tid-update-and-guidance-on-2019-novel-coronavirus-2019-ncov-for-transplant-id-clinicians | |
Agence de la Biomédecine | NR | https://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf | |
Belgian Transplantation Society | NR | https://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf | |
Dutch Transplantation Foundation | NR | https://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie | |
Organización Nacional de Trasplantes | NR | https://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf | |
NHS Blood and Transplant | NR | https://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/ | |
Swisstransplant | NR | English fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf | |
Latin America | Brazilian Association of Organ Transplantation | NR | http://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157 |
North America | American Association For The Study Of Liver Diseases | Y | https://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf |
American Society of Transplant Surgeons | NR | https://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl | |
Canadian Blood Services and Canadian Society of Transplantation | NR | https://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services | |
Organ Procurement and Transplantation Network | NR | TTS.ORG- pdf Information for transplant programs | |
United Network for Organ Sharing/American Society for Transplantation | NR | https://www.myast.org/covid-19-information https://unos.org/covid/ |
Exposure Assessment and Recipient Screening Recommendations
Societies generally recommend that prospective recipients of both living and deceased organ donation undergo symptomatic and viral PCR testing prior to transplant. Few societies comment on the use of CT chest imaging in potential donors to assess for findings of COVID-19 and in those that do they either recommend or conditionally recommend that this modality may be used.
International societies do not specifically address enhanced testing or assessment measures for potential recipients with known, recent COVID-19 positive contacts. It is recommended that these donors be deferred for 14 days from last contact.
Region | Institution | Recommendation regarding testing or symptom screening of potential deceased donation recipients? | Recommendation regarding testing of potential living donation recipients? | Recommend a wait time prior to consideration for donation after exposure to a known COVID-19 positive contact? | Recommend CT scan for potential donors? | Recommend additional screening/testing for prior to consideration for donation after exposure to a known COVID-19 positive contact? | Website/Source of Information |
---|---|---|---|---|---|---|---|
International | The International Society of Heart and Lung Transplantation | Y | NR | Y | Y | Y | https://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf |
International Liver Transplant Society | NR | NR | NR | NR | NR | https://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/ | |
The Transplantation Society | NR | NR | NR | NR | NR | https://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140 | |
Asia | Indian Society of Transplantation | Y | NR | Y | NR | NR | https://isot.co.in/file/ISOT_COVID_V1_March_26.pdf |
Korean Society for Transplantation | NR | NR | NR | NR | NR | http://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword= | |
Australasia | Australian Government Organ and Tissue Authority and The Transplantation Society of Australia and New Zealand | Y | Y | NR | NR | NR | https://www.tsanz.com.au/ |
Europe | European Centre for Disease Prevention and Control | Y | NR | NR | NR | NR | https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf |
European Society of Transplantation | N | Y | NR | NR | NR | https://tts.org/tid-about/tid-presidents-message/23-tid/tid-news/657-tid-update-and-guidance-on-2019-novel-coronavirus-2019-ncov-for-transplant-id-clinicians | |
Agence de la Biomédecine | NR | NR | NR | NR | NR | https://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf | |
Belgian Transplantation Society | Y | NR | NR | Y | NR | https://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf | |
Dutch Transplantation Society | Y | Y | NR | NR | NR | https://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie | |
Organización Nacional de Trasplantes | Y | Y | NR | NR | NR | https://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf | |
NHS Blood and Transplant | Y | Y | Y | NR | NR | https://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/ | |
Swisstransplant | Y | Y | Y | Y | Y | English fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf | |
Latin America | Brazilian Association of Organ Transplantation | Y | Y | Y | NR | NR | http://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157 |
North America | American Association For The Study Of Liver Diseases | Y | Y | NR | N | NR | https://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf |
American Society of Transplant Surgeons | Y | NR | NR | NR | NR | https://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl | |
Canadian Blood Services and Canadian Society of Transplantation | Y | Y | NR | NR | NR | https://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services | |
Organ Procurement and Transplantation Network | NR | NR | NR | NR | NR | TTS.ORG website - pdf Information for transplant programs | |
United Network for Organ Sharing/American Society for Transplantation | NR | NR | NR | NR | NR | https://www.myast.org/covid-19-information https://unos.org/covid/ |
If a transplant candidate develops COVID-19, societies most commonly recommend resolution of symptoms, at least 2 negative PCR tests and 14 days elapse before considering transplant eligible. Some groups recommend longer waiting periods of 21 or 28 days. Few societies comment on the possibility of lung transplant in individuals with severe lung disease related to COVID-19 and recommend a cautious and limited approach.
Region | Institution | Recommend wait time prior to transplant if travelled in an endemic area? | Recommend screening regimen to confirm clearance of COVID-19 for waitlist patients? | Recommend lung transplantation for patients with COVID-19 related lung diseases? | Recommend adding COVID-19 testing status to registry data? | Website/Source of Information |
---|---|---|---|---|---|---|
International | The International Society of Heart and Lung Transplantation | NR | Y | Y | NR | https://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf |
International Liver Transplant Society | Y | NR | NR | NR | https://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/ | |
The Transplantation Society | Y | Y | NR | Y | https://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140 | |
Asia | Indian Society of Transplantation | NR | NR | NR | NR | https://isot.co.in/file/ISOT_COVID_V1_March_26.pdf |
Korean Society for Transplantation | Y | NR | NR | NR | http://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword= | |
Australasia | Australian Government Organ and Tissue Authority and The Transplantation Society of Australia and New Zealand | NR | NR | NR | Y | https://www.tsanz.com.au/ |
Europe | European Centre for Disease Prevention and Control | NR | NR | NR | NR | https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf |
European Society of Transplantation | NR | NR | NR | NR | https://tts.org/tid-about/tid-presidents-message/23-tid/tid-news/657-tid-update-and-guidance-on-2019-novel-coronavirus-2019-ncov-for-transplant-id-clinicians | |
Agence de la Biomédecine | NR | NR | NR | NR | https://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf | |
Belgian Transplantation Society | NR | NR | NR | NR | https://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf | |
Dutch Transplantation Foundation | NR | NR | Y | NR | https://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie | |
Organización Nacional de Trasplantes | NR | Y | NR | NR | https://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf | |
NHS Blood and Transplant | NR | N | NR | Y | https://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/ | |
Swisstransplant | Y | Y | NR | NR | English fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf | |
Latin America | Brazilian Association of Organ Transplantation | NR | NR | NR | NR | http://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157 |
North America | American Association For The Study Of Liver Diseases | Y | Y | NR | Y | https://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf |
American Society of Transplant Surgeons | NR | NR | NR | NR | https://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl | |
Canadian Blood Services and Canadian Society of Transplantation | NR | NR | NR | NR | https://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services | |
Organ Procurement and Transplantation Network | NR | NR | NR | NR | TTS.ORG website - pdf Information for transplant programs | |
United Network for Organ Sharing/American Society for Transplantation | NR | NR | NR | NR | https://www.myast.org/covid-19-information https://unos.org/covid/ |
Post-Transplant Risk
There is limited guidance related to lymphocyte depleting therapy with most societies providing no recommendation in this regard. Similarly, most organizations make no recommendation about altering maintenance immunosuppression, though some explicitly recommend against adjustment of maintenance immunosuppression in asymptomatic transplant recipients.
Societies either do not comment or recommend against prophylactic anti-SARS-CoV-2 therapy at this time. ISHLT encourages enrollment of transplant recipients and individuals with chronic lung or cardiac disease into trials of prophylactic and therapeutic therapies.
Many organizations make no recommendation with regard to antiviral treatment of COVID-19. Some explicitly state there is not enough evidence to guide decisions regarding the use of COVID-19 treatment strategies in transplant patients. Other organizations do recommend specific antiviral treatments, although these vary significantly between organizations and are dependent on disease severity and underlying health conditions.
Region | Institution | Recommend avoidance or decrease of lymphocyte depleting regimens immediately post-transplant? | Recommend altering immunosuppression regimen in transplant patients not currently infected with COVID-19? | Recommend prophylactic anti-COVID-19 therapy? | Recommend modulation of immunosuppression if transplant recipient tests positive for COVID-19? | Recommend transplant recipient who tests positive for COVID-19 change immunotherapy themselves? | Recommend for or against specific anti-COVID-19 therapy? | Website/Source of Information |
---|---|---|---|---|---|---|---|---|
International | The International Society of Heart and Lung Transplantation | N | N | NR | Y | N | N | https://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf |
International Liver Transplant Society | NR | NR | NR | NR | NR | NR | https://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/ | |
The Transplantation Society | NR | NR | NR | NR | NR | NR | https://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140 | |
International Society of Nephrology | https://www.theisn.org/covid19/recommendations | |||||||
Asia | Indian Society of Transplantation | NR | NR | Y | NR | NR | NR | https://isot.co.in/file/ISOT_COVID_V1_March_26.pdf |
Korean Society for Transplantation | NR | NR | NR | NR | NR | NR | http://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword= | |
Australasia | Australian Government Organ and Tissue Authority and The Transplantation Society of Australia and New Zealand | NR | NR | NR | NR | NR | NR | https://www.tsanz.com.au/ |
Europe | European Centre for Disease Prevention and Control | NR | NR | NR | NR | NR | NR | https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf |
European Society of Transplantation | NR | NR | NR | NR | NR | NR | https://tts.org/tid-about/tid-presidents-message/23-tid/tid-news/657-tid-update-and-guidance-on-2019-novel-coronavirus-2019-ncov-for-transplant-id-clinicians | |
Agence de la Biomédecine | NR | NR | NR | NR | NR | NR | https://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf | |
Belgian Transplantation Society | NR | NR | NR | NR | NR | NR | https://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf | |
Dutch Transplantation Foundation | NR | N | NR | N | NR | NR | https://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie | |
Organización Nacional de Trasplantes | NR | NR | NR | NR | NR | NR | https://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf | |
NHS Blood and Transplant | NR | NR | NR | NR | NR | NR | https://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/ | |
Swisstransplant | Y | Y | Y | Y | Y | Y | English fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf | |
Latin America | Brazilian Association of Organ Transplantation | NR | NR | NR | NR | NR | NR | http://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157 |
North America | American Association For The Study Of Liver Diseases | NR | N | NR | Y | Y | Y | https://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf |
American Society of Transplant Surgeons | NR | N | N | Y | NR | N | https://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl | |
Canadian Blood Services and Canadian Society of Transplantation | NR | N | N | Y | N | NR | https://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services | |
Organ Procurement and Transplantation Network | NR | NR | NR | NR | NR | NR | TTS.ORG website - pdf Information for transplant programs | |
United Network for Organ Sharing/American Society for Transplantation | NR | NR | NR | NR | NR | NR | https://www.myast.org/covid-19-information https://unos.org/covid/ |
Although several societies advise that there may be an increased risk of acquisition of SARS-CoV-2 infection or a greater severity of disease, it is acknowledged that this is largely unknown. The recommendations provided about management of transplant recipients to reduce the risk of disease acquisition are in line with local public health recommendations and include a recommendation to self-isolate after international travel and to follow public health guidance pertaining to hand hygiene and social distancing. Regarding the wearing of masks, some jurisdictions recommend this for all individuals when in public which also applies to transplant recipients. Masks are especially recommended for any symptomatic transplant recipient to be worn during evaluation for COVID-19.
Region | Institution | Recommendation on self-isolation on return from travel? | Recommendation on PPE for transplant recipients visiting hospital or other high risk situation? | Recommend transplanted patients alter daily routine (e.g. self-isolation or hygiene)? | Comment on risk of viral acquisition or severe disease for immunosuppressed patients? | Recommend limitation of visitors to post-transplant recipients? | Recommendation on transplant recipients wearing masks in daily life? | Website/Source of Information |
---|---|---|---|---|---|---|---|---|
International | The International Society of Heart and Lung Transplantation | NR | Y | Y | Y | Y | Y | https://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf |
International Liver Transplant Society | Y | NR | Y | NR | NR | NR | https://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/ | |
The Transplantation Society | NR | Y | Y | NR | NR | NR | https://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140 | |
International Society of Nephrology | N/A | N/A | N/A | N/A | N/A | N/A | https://www.theisn.org/covid19/recommendations | |
Asia | Indian Society of Transplantation | Y | Y | Y | NR | NR | NR | https://isot.co.in/file/ISOT_COVID_V1_March_26.pdf |
Korean Society for Transplantation | Y | Y | NR | NR | NR | NR | http://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword= | |
Australasia | Australian Government Organ and Tissue Authority and The Transplantation Society of Australia and New Zealand | NR | NR | NR | NR | NR | NR | https://www.tsanz.com.au/ |
Europe | European Centre for Disease Prevention and Control | NR | NR | NR | Y | NR | NR | https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf |
European Society of Transplantation | Y | Y | NR | NR | NR | NR | https://tts.org/tid-about/tid-presidents-message/23-tid/tid-news/657-tid-update-and-guidance-on-2019-novel-coronavirus-2019-ncov-for-transplant-id-clinicians | |
Agence de la Biomédecine | NR | NR | NR | NR | NR | NR | https://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf | |
Belgian Transplantation Society | NR | Y | NR | Y | NR | NR | https://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf | |
Dutch Transplantation Foundation | NR | NR | Y | Y | Y | NR | https://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie | |
Organización Nacional de Trasplantes | NR | NR | NR | NR | NR | NR | https://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf | |
NHS Blood and Transplant | Y | NR | Y | NR | NR | NR | https://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/ | |
Swisstransplant | Y | Y | N | Y | N | N | English fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf | |
Latin America | Brazilian Association of Organ Transplantation | NR | Y | Y | NR | NR | N | http://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157 |
North America | American Association For The Study Of Liver Diseases | Y | Y | Y | Y | NR | NR | https://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf |
American Society of Transplant Surgeons | NR | NR | NR | NR | NR | NR | https://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl | |
Canadian Blood Services and Canadian Society of Transplantation | NR | NR | NR | NR | NR | NR | https://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services | |
Organ Procurement and Transplantation Network | NR | NR | NR | NR | NR | NR | TTS.ORG website - pdf Information for transplant programs | |
United Network for Organ Sharing/American Society for Transplantation | NR | Y | Y | Y | NR | Y | https://www.myast.org/covid-19-information https://unos.org/covid/ |
Society guidance recommendations align with hospital infection prevention and control as well as public health recommendations where COVID-19 positive patients should be geographically separated from transplant wards and any suspected COVID-19 positive patient should be alerted to public health. In an effort to minimize transmission, several societies recommend limiting non-essential clinic and diagnostic appointments and limiting visitors. Transplant recipients with fever or respiratory or gastrointestinal symptoms should inform their transplant team.
Region | Institution | Recommendation on when transplant recipient should contact provider? | Recommend limiting reduction in hospital visits or contact with healthcare workers for transplanted patients ? | Recommend limitation of visitors to post-transplant recipients? | Recommend physical separation of transplant recipients within hospitals from COVID-19 + patients? | Recommendation on contacting public health authority with suspected COVID-19 + patient? | Website/Source of Information |
---|---|---|---|---|---|---|---|
International | The International Society of Heart and Lung Transplantation | NR | NR | NR | NR | NR | https://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf |
International Liver Transplant Society | NR | NR | NR | NR | NR | https://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/ | |
The Transplantation Society | NR | Y | NR | NR | Y | https://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140 | |
International Society of Nephrology | N/A | N/A | N/A | N/A | N/A | https://www.theisn.org/covid19/recommendations | |
Asia | Indian Society of Transplantation | Y | Y | NR | NR | NR | https://isot.co.in/file/ISOT_COVID_V1_March_26.pdf |
Korean Society for Transplantation | NR | NR | NR | NR | NR | http://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword= | |
Australasia | Australian Government Organ and Tissue Authority and The Transplantation Society of Australia and New Zealand | NR | NR | NR | NR | Y | https://www.tsanz.com.au/ |
Europe | European Centre for Disease Prevention and Control | NR | NR | NR | NR | NR | https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf |
European Society of Transplantation | NR | Y | NR | NR | NR | https://tts.org/tid-about/tid-presidents-message/23-tid/tid-news/657-tid-update-and-guidance-on-2019-novel-coronavirus-2019-ncov-for-transplant-id-clinicians | |
Agence de la Biomédecine | NR | NR | NR | NR | NR | https://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf | |
Belgian Transplantation Society | NR | NR | NR | NR | NR | https://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf | |
Dutch Transplantation Foundation | Y | Y | Y | Y | NR | https://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie | |
Organización Nacional de Trasplantes | NR | NR | NR | NR | NR | https://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf | |
NHS Blood and Transplant | Y | Y | NR | Y | NR | https://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/ | |
Swisstransplant | Y | Y | N | Y | NR | English fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf | |
Latin America | Brazilian Association of Organ Transplantation | Y | Y | NR | NR | NR | http://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157 |
North America | American Association For The Study Of Liver Diseases | NR | Y | Y | Y | Y | https://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf |
American Society of Transplant Surgeons | NR | NR | NR | NR | NR | https://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl | |
Canadian Blood Services and Canadian Society of Transplantation | NR | NR | NR | NR | NR | https://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services | |
Organ Procurement and Transplantation Network | NR | NR | NR | NR | NR | TTS.ORG website - pdf Information for transplant programs | |
United Network for Organ Sharing/American Society for Transplantation | Y | NR | NR | NR | Y | https://www.myast.org/covid-19-information https://unos.org/covid/ |
Deceased Donation Recommendations
No group recommends outright suspension of all deceased donation and transplant activity. As long as it is considered safe, most groups recommend proceeding with donation and transplantation be assessed on a case by case basis. One group suggests temporary suspension of the deceased donor program be considered when resources at the transplant center may be constrained.
No group recommends outright suspension of all deceased donation and transplant activity. As long as it is considered safe, most groups recommend proceeding with donation and transplantation be assessed on a case by case basis. One group suggests temporary suspension of the deceased donor program be considered when resources at the transplant center may be constrained.
Region | Institution | Recommendation on suspension of deceased kidney/pancreas donation? | Website/Source |
---|---|---|---|
International | The International Society of Heart and Lung Transplantation | NR | https://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf |
International Liver Transplant Society | NR | https://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/ | |
The Transplantation Society | Y | https://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140 | |
Asia | Indian Society of Transplantation | NR | https://isot.co.in/file/ISOT_COVID_V1_March_26.pdf |
Korean Society for Transplantation | NR | http://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword= | |
Australasia | Australian Government Organ and Tissue Authority and The Transplantation Society of Australia and New Zealand | NR | https://www.tsanz.com.au/ |
Europe | European Centre for Disease Prevention and Control | NR | https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf |
European Society of Transplantation | Y | https://tts.org/tid-about/tid-presidents-message/23-tid/tid-news/657-tid-update-and-guidance-on-2019-novel-coronavirus-2019-ncov-for-transplant-id-clinicians | |
Agence de la Biomédecine | Y | https://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf | |
Belgian Transplantation Society | Y | https://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf | |
Dutch Transplantation Foundation | N | https://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie | |
Organización Nacional de Trasplantes | NR | https://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf | |
NHS Blood and Transplant | N | https://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/ | |
Swisstransplant | NR | English fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf | |
Latin America | Brazilian Association of Organ Transplantation | Y | http://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157 |
North America | American Association For The Study Of Liver Diseases | NR | https://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf |
American Society of Transplant Surgeons | NR | https://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl | |
Canadian Blood Services and Canadian Society of Transplantation | N | https://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services | |
Organ Procurement and Transplantation Network | NR | TTS.ORG - pdf Information for transplant programs | |
United Network for Organ Sharing/American Society for Transplantation | NR | https://www.myast.org/covid-19-information https://unos.org/covid/ |
No group recommends outright suspension of all deceased donation and transplant activity. As long as it is considered safe, most groups recommend proceeding with donation and transplantation be assessed on a case by case basis. One group suggests temporary suspension of the deceased donor program be considered when resources at the transplant center may be constrained.
Region | Institution | Recommendation on suspension of deceased liver donation? | Recommend alteration of deceased liver organ donation and transplantation? | Website/Source of Information |
---|---|---|---|---|
International | The International Society of Heart and Lung Transplantation | NR | NR | https://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf |
International Liver Transplant Society | NR | NR | https://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/ | |
The Transplantation Society | Y | NR | https://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140 | |
Asia | Indian Society of Transplantation | NR | NR | https://isot.co.in/file/ISOT_COVID_V1_March_26.pdf |
Korean Society for Transplantation | NR | NR | http://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword= | |
Australasia | Australian Government Organ and Tissue Authority and The Transplantation Society of Australia and New Zealand | NR | NR | https://www.tsanz.com.au/ |
Europe | European Centre for Disease Prevention and Control | NR | NR | https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf |
European Society of Transplantation | Y | NR | https://tts.org/tid-about/tid-presidents-message/23-tid/tid-news/657-tid-update-and-guidance-on-2019-novel-coronavirus-2019-ncov-for-transplant-id-clinicians | |
Agence de la Biomédecine | Y | NR | https://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf | |
Belgian Transplantation Society | Y | Y | https://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf | |
Dutch Transplantation Foundation | N | NR | https://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie | |
Organización Nacional de Trasplantes | N | N | https://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf | |
NHS Blood and Transplant | N | NR | https://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/ | |
Swisstransplant | N | N | English fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf | |
Latin America | Brazilian Association of Organ Transplantation | Y | NR | http://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157 |
North America | American Association For The Study Of Liver Diseases | N | N | https://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf |
American Society of Transplant Surgeons | NR | NR | https://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl | |
Canadian Blood Services and Canadian Society of Transplantation | NR | NR | https://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services | |
Organ Procurement and Transplantation Network | NR | NR | TTS.ORG website - pdf Information for transplant programs | |
United Network for Organ Sharing/American Society for Transplantation | NR | NR | https://www.myast.org/covid-19-information https://unos.org/covid/ |
No group recommends outright suspension of all deceased donation and transplant activity. As long as it is considered safe, most groups recommend proceeding with donation and transplantation be assessed on a case by case basis. One group suggests temporary suspension of the deceased donor program be considered when resources at the transplant center may be constrained.
Region | Institution | Recommendation on suspension of thoracic organ donation and transplantation? | Recommend alteration of thoracic organ donation and transplantation? | Recommendation on cardiac donation and transplantation? | Recommendation on suspension of pulmonary donation and transplantation? | Website/Source of Information |
---|---|---|---|---|---|---|
International | The International Society of Heart and Lung Transplantation | N | Y | Y | Y | https://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf |
International Liver Transplant Society | NR | NR | NR | NR | https://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/ | |
The Transplantation Society | Y | NR | NR | NR | https://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140 | |
Asia | Indian Society of Transplantation | NR | NR | NR | NR | https://isot.co.in/file/ISOT_COVID_V1_March_26.pdf |
Korean Society for Transplantation | NR | NR | NR | NR | http://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword= | |
Australasia | Australian Government Organ and Tissue Authority and The Transplantation Society of Australia and New Zealand | NR | NR | NR | NR | https://www.tsanz.com.au/ |
Europe | European Centre for Disease Prevention and Control | NR | NR | NR | NR | https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf |
European Society of Transplantation | Y | Y | Y | Y | https://tts.org/tid-about/tid-presidents-message/23-tid/tid-news/657-tid-update-and-guidance-on-2019-novel-coronavirus-2019-ncov-for-transplant-id-clinicians | |
Agence de la Biomédecine | NR | Y | Y | NR | https://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf | |
Belgian Transplantation Society | N | Y | Y | Y | https://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf | |
Dutch Transplantation Foundation | N | NR | N | N | https://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie | |
Organización Nacional de Trasplantes | N | N | N | N | https://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf | |
NHS Blood and Transplant | N | N | N | N | https://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/ | |
Swisstransplant | N | Y | Y | Y | English fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf | |
Latin America | Brazilian Association of Organ Transplantation | NR | NR | NR | NR | http://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157 |
North America | American Association For The Study Of Liver Diseases | NR | NR | NR | NR | https://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf |
American Society of Transplant Surgeons | NR | NR | NR | NR | https://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl | |
Canadian Blood Services and Canadian Society of Transplantation | NR | NR | NR | NR | https://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services | |
Organ Procurement and Transplantation Network | NR | NR | NR | NR | TTS.ORG website - pdf Information for transplant programs | |
United Network for Organ Sharing/American Society for Transplantation | NR | NR | NR | NR | https://www.myast.org/covid-19-information https://unos.org/covid/ |
Living Donation / Paired Donation Recommendations
No group recommends outright suspension of all living donation/paired exchange activity. As long as it is considered safe, most groups recommend proceeding with donation and transplantation be assessed on a case by case basis. One group suggests temporary suspension of the deceased donor program be considered when resources at the transplant center may be constrained.
The majority of guidance recommends symptom screening and PCR testing of all living donors. There is limited and variable guidance around management of living donors with a prior history of resolved COVID-19.
If these programs or individual transplants continue, it is uniformly recommended that potential living donors take every measure to limit the acquisition of COVID-19 prior to donation. Some programs suggest this should include deferral of donation and self isolation for 14 – 21 days after international travel and strict social distancing measures in the 14 days leading up to transplant.
Region | Institution | Recommend current suspension of Living Kidney Donation? | Recommend current suspension of Living Liver Donation? | Recommend symptom screening of potential living donors? | Recommend wait period after international travel or other epidemiological risk prior to consideration for living donation? | Recommend COVID-19 testing of all potential living donors? | Recommend testing regimen for documenting clearance of confirmed COVID-19 in potential living donors? | Recommend social distancing/no travel etc. for potential living donors? | Recommend suspending KPD programs? | Website/Source of Information |
---|---|---|---|---|---|---|---|---|---|---|
International | The International Society of Heart and Lung Transplantation | NR | NR | NR | NR | NR | NR | NR | NR | https://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf |
International Liver Transplant Society | NR | NR | NR | Y | NR | NR | NR | NR | https://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/ | |
The Transplantation Society | Y | Y | Y | Y | N | NR | NR | NR | https://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140 | |
Asia | Indian Society of Transplantation | Y | Y | Y | NR | Y | NR | NR | NR | https://isot.co.in/file/ISOT_COVID_V1_March_26.pdf |
Korean Society for Transplantation | N | N | Y | Y | Y | NR | NR | NR | ||
Australasia | Australian Government Organ and Tissue Authority and The Transplantation Society of Australia and New Zealand | NR | NR | NR | NR | Y | Y | NR | NR | https://www.tsanz.com.au/ |
Europe | European Centre for Disease Prevention and Control | NR | NR | NR | Y | Y | NR | NR | NR | https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf |
European Society of Transplantation | NR | NR | NR | NR | NR | NR | NR | NR | https://tts.org/tid-about/tid-presidents-message/23-tid/tid-news/657-tid-update-and-guidance-on-2019-novel-coronavirus-2019-ncov-for-transplant-id-clinicians | |
Agence de la Biomédecine | N | NR | Y | NR | NR | NR | NR | NR | https://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf | |
Belgian Transplantation Society | Y | NR | NR | NR | NR | NR | NR | NR | https://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf | |
Dutch Transplantation Foundation | Y | Y | Y | NR | NR | NR | NR | NR | https://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie | |
Organización Nacional de Trasplantes | N | N | Y | N | Y | Y | NR | NR | https://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf | |
NHS Blood and Transplant | NR | NR | Y | NR | N | Y | Y | NR | https://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/ | |
Swisstransplant | N | N | Y | Y | Y | Y | Y | NR | English fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf | |
Latin America | Brazilian Association of Organ Transplantation | NR | NR | NR | NR | NR | NR | NR | NR | http://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157 |
North America | American Association For The Study Of Liver Diseases | N | N | Y | Y | Y | Y | Y | Y | https://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf |
American Society of Transplant Surgeons | N | N | Y | NR | Y | NR | NR | NR | https://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl | |
Canadian Blood Services and Canadian Society of Transplantation | N | N | Y | Y | Y | Y | Y | Y | https://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services | |
Organ Procurement and Transplantation Network | NR | NR | NR | NR | NR | NR | NR | NR | TTS.ORG website - pdf Information for transplant programs | |
United Network for Organ Sharing/American Society for Transplantation | NR | NR | NR | NR | NR | NR | NR | NR | https://www.myast.org/covid-19-information https://unos.org/covid/ |
Organ Donation and Transplant Professionals’ Personal Protective Equipment (PPE) use
Recommendations for ODT professionals following contact with COVID-19 confirmed or suspected patients (column 2)
The groups that commented on this issue generally recommended that ODT staff should follow existing recommendations for other health care professionals after confirmed or potential COVID-19 exposure.
Routine use (columns 3 and 5)
Most groups issued recommendations regarding PPE use. Most commonly they encouraged adherence to national and local practices regarding the types of PPE used in different situations. Some specifically noted that full and adequate PPE must be made available to ODT professionals, either through the associated organ donation organization (ODO) or hospital system. A few organizations recommended routine use of universal precautions (surgical mask and gloves) for all patient encounters, regardless of local recommendations.
PPE requirements for ODT professionals during potentially aerosolizing procedures (e.g. bronchoscopy or extubation in the operating room) (column 4)
Some groups specifically mention airborne transmission precautions and the need to ensure that ODT professionals have access to appropriate equipment – particularly N95 masks – if they are present during these procedures.
Alteration of staff routine to decrease transmission (columns 5 and 6)
Several groups recommend that ODOs should alter their routines to encourage social distancing as much as possible. Suggested means included encouraging of videoconferencing, limiting of staff travel between hospitals when possible, and following social distancing protocols in ODO offices or facilities. One group mentioned that consideration should be given for staff with underlying risk factors for disease severity (e.g. immunosuppression, advanced age) to avoid unnecessary presence in hospitals or direct patient contact.
Region | Institution | 1. Include Recommendations for ODT professionals' PPE Use | 2. Recommend following hospital procedures when in contact with COVID-19 + or suspected patients | 3. Recommend application of routine surgical masks and gloves for all patient encounters | 4. Recommend PPE requirements for certain procedures (e.g. bronchoscopy or OR)? | 5. Recommend alteration of staff routine (e.g. decreasing face to face interactions, working from home)? | 6. Recommend alteration of staff requirements for certain populations? | Website/Source of Information |
---|---|---|---|---|---|---|---|---|
International | The International Society of Heart and Lung Transplantation | Y | NR | NR | Y | Y | NR | https://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf |
International Liver Transplant Society | Y | NR | NR | NR | NR | NR | https://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/ | |
The Transplantation Society | NR | NR | NR | NR | NR | NR | https://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140 | |
Asia | Indian Society of Transplantation | Y | Y | NR | NR | Y | NR | https://isot.co.in/file/ISOT_COVID_V1_March_26.pdf |
Korean Society for Transplantation | Y | Y | Y | NR | Y | NR | http://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword= | |
Australasia | Australian Government Organ and Tissue Authority and The Transplantation Society of Australia and New Zealand | Y | NR | NR | NR | NR | NR | https://www.tsanz.com.au/ |
Europe | European Centre for Disease Prevention and Control | Y | NR | NR | NR | Y | NR | https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf |
European Society of Transplantation | NR | NR | NR | NR | NR | NR | https://tts.org/tid-about/tid-presidents-message/23-tid/tid-news/657-tid-update-and-guidance-on-2019-novel-coronavirus-2019-ncov-for-transplant-id-clinicians | |
Agence de la Biomédecine | NR | NR | NR | NR | NR | NR | https://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf | |
Belgian Transplantation Society | NR | NR | NR | NR | NR | NR | https://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf | |
Dutch Transplantation Foundation | Y | NR | NR | NR | NR | NR | https://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie | |
Organización Nacional de Trasplantes | NR | NR | NR | NR | NR | NR | https://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf | |
NHS Blood and Transplant | Y | Y | N | N | Y | NR | https://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/ | |
Swisstransplant | Y | Y | Y | Y | N | N | English fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf | |
Latin America | Brazilian Association of Organ Transplantation | NR | NR | NR | NR | NR | NR | http://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157 |
North America | American Association For The Study Of Liver Diseases | Y | Y | Y | Y | Y | Y | https://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf |
American Society of Transplant Surgeons | NR | NR | NR | NR | NR | NR | https://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl | |
Canadian Blood Services and Canadian Society of Transplantation | Y | Y | Y | Y | Y | NR | https://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services | |
Organ Procurement and Transplantation Network | NR | NR | NR | NR | NR | NR | TTS.ORG website - pdf Information for transplant programs | |
United Network for Organ Sharing/American Society for Transplantation | Y | Y | Y | Y | NR | NR | https://www.myast.org/covid-19-information https://unos.org/covid/ |
Additional Recommendations
Need to inform potential recipients regarding issues around COVID-19 infection risk or need for enhanced isolation post-transplant (column 1)
Many groups recommended that if a transplantation was deemed medically necessary during the pandemic, potential recipients should be clearly informed of the additional potential risks of COVID-19 infection post-transplant and that strict, prolonged isolation would likely be required.
Consideration balance of liberating intensive care unit (ICU) resources through successful transplantation against ICU need post-transplantation (column 2)
Almost all groups recognized the potential for the pandemic to create surge demand for ICU resources that would strain a hospital’s capacity to care for patients who are potential donors or recipients requiring ICU post-transplant. However, some groups mentioned that the need to limit excess burden on the system through donation and transplantation must be balanced against the potential to liberate ICU resources through transplantation. They state that transplanting a patient hospitalized in the ICU for terminal hepatic or cardiac failure might actually decrease overall system burden by allowing that patient to be transferred to the ward. All groups were careful to state that these decisions must be made considering current conditions of the entire health system and that sweeping recommendations that would apply to all cases would not be possible.
Risk of transplant may outweigh benefit
Several transplantation groups stated that while the medical and societal benefits of transplant in ordinary times are clear, in general, it is advised to undertake a risk assessment to determine which patients would benefit from transplant, despite increased risk of infection.
Region | Institution | 1. Recommend informing potential recipients specifically regarding issues such COVID-19 infection risk or need for enhanced isolation post-transplant? | 2. Recommend consideration balance of liberating ICU resources through successful transplantation against ICU need post-transplantation? | 3. Recommends risk of transplant may out weigh benefit | 4. Recommends ensure recipient is available for organs prior to initiation | Website/Source of Information |
---|---|---|---|---|---|---|
International | The International Society of Heart and Lung Transplantation | Y | Y | NR | NR | https://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf |
International Liver Transplant Society | NR | NR | NR | NR | https://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/ | |
The Transplantation Society | NR | Y | NR | NR | https://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140 | |
Asia | Indian Society of Transplantation | Y | NR | NR | NR | https://isot.co.in/file/ISOT_COVID_V1_March_26.pdf |
Korean Society for Transplantation | NR | NR | NR | NR | http://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword= | |
Australasia | Australian Government Organ and Tissue Authority and The Transplantation Society of Australia and New Zealand | NR | NR | NR | NR | https://www.tsanz.com.au/ |
Europe | European Centre for Disease Prevention and Control | NR | NR | NR | NR | https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf |
European Society of Transplantation | NR | NR | NR | NR | https://tts.org/tid-about/tid-presidents-message/23-tid/tid-news/657-tid-update-and-guidance-on-2019-novel-coronavirus-2019-ncov-for-transplant-id-clinicians | |
Agence de la Biomédecine | Y | NR | NR | NR | https://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf | |
Belgian Transplantation Society | NR | NR | Y | Y | https://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf | |
Dutch Transplantation Foundation | NR | NR | Y | NR | https://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie | |
Organización Nacional de Trasplantes | NR | NR | NR | NR | https://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf | |
NHS Blood and Transplant | Y | Y | Y | NR | https://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/ | |
Swisstransplant | Y | Y | Y | Y | English fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf | |
Latin America | Brazilian Association of Organ Transplantation | NR | NR | NR | NR | http://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157 |
North America | American Association For The Study Of Liver Diseases | Y | Y | Y | Y | https://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf |
American Society of Transplant Surgeons | NR | NR | NR | NR | https://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl | |
Canadian Blood Services and Canadian Society of Transplantation | Y | NR | NR | NR | https://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services | |
Organ Procurement and Transplantation Network | NR | NR | NR | NR | TTS website - pdf Information for transplant programs | |
United Network for Organ Sharing/American Society for Transplantation | NR | NR | NR | NR | https://www.myast.org/covid-19-information https://unos.org/covid/ |
Ensure recipient and equipment is available for organs prior to initiation (columns 1 and 4)
Considering the decreased availability of resources, especially during the early stages of the pandemic, it is recommended that ODOs and transplant programs ensure that there are potential recipients who are medically eligible and willing to receive the organ prior to committing resources to the donation and recovery process. This recognizes that it would be inadvisable in a resource limited setting to commit ICU or ODO resources to cases that are unlikely to proceed to actual donation and transplantation. Ensuring an adequate supply of PPE, ventilators and blood products is also recommended.
Local recovery team and shipping of organs (column 1)
Several groups recommended that in the case where the donor and recipient are in different geographic locations, recovery should be performed by local teams whenever possible and the organ shipped in order to limit the amount of travel required by recovery teams.
Transplantation in a designated non-COVID-19 facility with limited exposure to potential COVID-19 patients (columns 2 and 6)
While not available in all systems, a few groups recommended that when possible transplantation and subsequent care should take place in facilities or sections of a hospital that are designated as COVID-19 free and capable of admitting only patients who are confirmed or suspected to be COVID-19.
Region | Institution | 1. Recommends ensure recipient is available for organs prior to initiation | 2. Recommend local recovery team and shipping of organs? | 3. Recommend transplant take place in a designated non-COVID-19 facility? | 4. Recommend listing or transplanting waitlisted patients in a geographic area with less viral transmission? | 5. Recommend confirmation of equipment (PPE etc.) prior to acceptance of organ offer? | 6. Recommend decreased need for post-transplant follow-up reporting or data entry? | 7. Recommend isolation of recipients from patients with inconclusive screening? | Website/Source of Information |
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International | The International Society of Heart and Lung Transplantation | NR | Y | NR | NR | Y | NR | NR | https://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf |
International Liver Transplant Society | NR | NR | NR | NR | NR | NR | NR | https://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/ | |
The Transplantation Society | NR | NR | NR | NR | NR | NR | Y | https://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140 | |
Asia | Indian Society of Transplantation | NR | NR | Y | NR | NR | NR | NR | https://isot.co.in/file/ISOT_COVID_V1_March_26.pdf |
Korean Society for Transplantation | NR | NR | NR | NR | NR | NR | NR | http://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword= | |
Australasia | Australian Government Organ and Tissue Authority and The Transplantation Society of Australia and New Zealand | NR | NR | NR | NR | NR | NR | NR | https://www.tsanz.com.au/ |
Europe | European Centre for Disease Prevention and Control | NR | NR | Y | NR | NR | NR | NR | https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf |
European Society of Transplantation | NR | NR | NR | NR | NR | NR | NR | https://tts.org/tid-about/tid-presidents-message/23-tid/tid-news/657-tid-update-and-guidance-on-2019-novel-coronavirus-2019-ncov-for-transplant-id-clinicians | |
Agence de la Biomédecine | NR | NR | NR | NR | NR | NR | NR | https://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf | |
Belgian Transplantation Society | Y | Y | NR | NR | NR | NR | NR | https://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf | |
Dutch Transplantation Foundation | NR | Y | Y | NR | NR | NR | NR | https://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie | |
Organización Nacional de Trasplantes | NR | NR | NR | NR | NR | NR | NR | https://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf | |
NHS Blood and Transplant | NR | NR | Y | NR | NR | NR | NR | https://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/ | |
Swisstransplant | NR | Y | Y | Y | Y | N | N | English fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf | |
Latin America | Brazilian Association of Organ Transplantation | NR | NR | NR | NR | NR | NR | NR | http://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157 |
North America | American Association For The Study Of Liver Diseases | Y | NR | Y | NR | Y | NR | NR | https://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf |
American Society of Transplant Surgeons | NR | NR | NR | NR | NR | NR | NR | https://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl | |
Canadian Blood Services and Canadian Society of Transplantation | NR | Y | NR | NR | NR | NR | NR | https://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services | |
Organ Procurement and Transplantation Network | NR | NR | NR | NR | NR | NR | NR | TTS website - pdf Information for transplant programs | |
United Network for Organ Sharing/American Society for Transplantation | NR | NR | NR | NR | NR | NR | NR | https://www.myast.org/covid-19-information https://unos.org/covid/ |
International guidance documents recognize that transplant candidates on the waitlist are potentially at greater risk of complications related to COVID-19 given their end stage organ disease status and the requirement to defer transplant if they become infected. However, there is minimal guidance regarding enhanced screening and testing in wait list patients.
Region | Institutions | Recommendation or comment on risk of COVID infection for patients waitlisted for transplantation? | Recommend limiting reduction in hospital visits or contact with healthcare workers for waitlisted patients ? | Recommend alteration of routine surveillance of waitlisted patients? | Recommend waitlisted patients alter daily routine (e.g. self-isolation or hygiene)? | Recommend enhanced screening or testing of waitlist patients for COVID-19 | Recommendation on number of patients in a room? | Website/Source of Information |
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International | The International Society of Heart and Lung Transplantation | Y | Y | N | N | Y | NR | https://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf |
International Liver Transplant Society | NR | NR | NR | NR | NR | NR | https://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/ | |
The Transplantation Society | Y | Y | Y | Y | NR | NR | https://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140 | |
Asia | Indian Society of Transplantation | Y | Y | NR | NR | NR | NR | https://isot.co.in/file/ISOT_COVID_V1_March_26.pdf |
Korean Society for Transplantation | NR | NR | NR | NR | Y | NR | http://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword= | |
Australasia | Australian Government Organ and Tissue Authority and The Transplantation Society of Australia and New Zealand | NR | NR | NR | NR | NR | NR | International Dropbox |
Europe | European Centre for Disease Prevention and Control | NR | NR | NR | NR | NR | Y | https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf |
European Society of Transplantation | NR | NR | NR | NR | NR | NR | https://tts.org/tid-about/tid-presidents-message/23-tid/tid-news/657-tid-update-and-guidance-on-2019-novel-coronavirus-2019-ncov-for-transplant-id-clinicians | |
Agence de la Biomédecine | NR | NR | NR | NR | NR | NR | https://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf | |
Belgian Transplantation Society | NR | NR | NR | NR | NR | NR | https://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf | |
Dutch Transplantation Foundation | Y | Y | NR | NR | NR | NR | https://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie | |
Organización Nacional de Trasplantes | NR | NR | NR | NR | NR | NR | https://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf | |
NHS Blood and Transplant | Y | Y | N | NR | Y | Y | https://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/ | |
Swisstransplant | Y | N | Y | N | Y | N | English fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf | |
Latin America | Brazilian Association of Organ Transplantation | NR | NR | NR | NR | NR | NR | http://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157 |
North America | American Association For The Study Of Liver Diseases | Y | Y | Y | NR | NR | Y | https://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf |
American Society of Transplant Surgeons | NR | NR | NR | NR | NR | NR | https://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl | |
Canadian Blood Services and Canadian Society of Transplantation | NR | NR | NR | NR | NR | NR | https://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services | |
Organ Procurement and Transplantation Network | NR | NR | Y | NR | N | NR | TTS website - pdf Information for transplant programs | |
United Network for Organ Sharing/American Society for Transplantation | NR | NR | NR | NR | NR | NR | https://www.myast.org/covid-19-information https://unos.org/covid/ |
Most organizations suggest the potential advantages of vaccination in transplant recipients outweighs any potential concerns about reduced efficacy and/ or perceived lack of safety. Accordingly, these organizations recommend transplant recipients should receive the COVID-19 vaccine. In immediate pre- and post- transplantation settings, the ideal timing of vaccination is uncertain and recommendations vary.
Region | Institution | Recommend transplant recipients receive the COVID vaccine | Recommend when transplant recipients should be vaccinated post-transplant? | Recommend when wait-list candidates should be vaccinated pre-transplant? | Website/Source of Information |
---|---|---|---|---|---|
International | The International Society of Heart and Lung Transplantation | Y | Y | Y | https://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf |
International Liver Transplant Society | NR | NR | NR | https://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/ | |
The Transplantation Society | Y | Y | Y | https://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140 | |
Asia | Indian Society of Transplantation | NR | NR | NR | https://isot.co.in/file/ISOT_COVID_V1_March_26.pdf |
Korean Society for Transplantation | NR | NR | NR | http://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword= | |
Australasia | Australian Government Organ and Tissue Authority and The Transplantation Society of Australia and New Zealand | NR | NR | NR | https://www.tsanz.com.au/ |
Europe | European Centre for Disease Prevention and Control | NR | NR | NR | https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf |
European Society of Transplantation | NR | NR | NR | https://tts.org/tid-about/tid-presidents-message/23-tid/tid-news/657-tid-update-and-guidance-on-2019-novel-coronavirus-2019-ncov-for-transplant-id-clinicians | |
Agence de la Biomédecine | NR | NR | NR | https://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf | |
Belgian Transplantation Society | NR | NR | NR | https://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf | |
Dutch Transplantation Foundation | Y | Y | Y | https://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie | |
Organización Nacional de Trasplantes | NR | NR | NR | https://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf | |
NHS Blood and Transplant | Y | Y | Y | https://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/ | |
Swisstransplant | NR | NR | NR | English fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf | |
Latin America | Brazilian Association of Organ Transplantation | Y | N | N | http://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157 |
North America | American Association For The Study Of Liver Diseases | Y | Y | NR | https://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf |
American Society of Transplant Surgeons | NR | NR | NR | https://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl | |
Canadian Blood Services and Canadian Society of Transplantation | Y | Y | Y | https://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services | |
Organ Procurement and Transplantation Network | NR | NR | NR | TTS website - pdf Information for transplant programs | |
United Network for Organ Sharing/American Society for Transplantation | Y | Y | Y | https://www.myast.org/covid-19-information https://unos.org/covid/ |