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.

RegionInstitutionRecommend Screening for all Potential Donors?Recommend screening for respiratory infection symptoms or epidemiologic factors regardless of testing result?Website/Source of Information
InternationalThe International Society of Heart and Lung Transplantation YYhttps://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf
International Liver Transplant SocietyNRNRhttps://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/
The Transplantation Society YNRhttps://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140
AsiaIndian Society of TransplantationYNRhttps://isot.co.in/file/ISOT_COVID_V1_March_26.pdf
Korean Society for TransplantationYNRhttp://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword=
AustralasiaAustralian Government Organ and Tissue Authority and The Transplantation Society of Australia and New ZealandYYhttps://www.tsanz.com.au/
EuropeEuropean Centre for Disease Prevention and ControlYNRhttps://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf
European Society of TransplantationNYhttps://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 YNRhttps://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf
Belgian Transplantation SocietyYNRhttps://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf
Dutch Transplantation FoundationYNRhttps://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie
Organización Nacional de Trasplantes YYhttps://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf
NHS Blood and TransplantYNRhttps://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/
SwisstransplantYYEnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
Latin AmericaBrazilian Association of Organ TransplantationNRNRhttp://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157
North AmericaAmerican Association For The Study Of Liver DiseasesYYhttps://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf
American Society of Transplant SurgeonsYNRhttps://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl
Canadian Blood Services and Canadian Society of TransplantationYNRhttps://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services
Organ Procurement and Transplantation Network NRNRTTS.ORG - pdf Information for transplant programs
United Network for Organ Sharing/American Society for Transplantation NRNRhttps://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.

RegionInstitution1. Recommend Nasopharyngeal Swab PCR Testing2. Recommend Oropharyngeal Swab PCR Testing3. Recommend Preferential use of Bronchial Secretion for PCR Testing4. 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
InternationalThe International Society of Heart and Lung Transplantation YYYYYNRhttps://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf
International Liver Transplant SocietyNRNRNRNRNRNRhttps://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/
The Transplantation Society NRNRNRYNRNRhttps://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140
AsiaIndian Society of TransplantationNRNRNRYNRNRhttps://isot.co.in/file/ISOT_COVID_V1_March_26.pdf
Korean Society for TransplantationNRNRNRYNRNR http://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword=
AustralasiaAustralian Government Organ and Tissue Authority and The Transplantation Society of Australia and New ZealandYYYYNRNhttps://www.tsanz.com.au/
EuropeEuropean Centre for Disease Prevention and ControlYNRNRYNRNRhttps://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf
European Society of TransplantationYYYYNRNRhttps://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 YNRNNRNRYhttps://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf
Belgian Transplantation SocietyYNRNNYNRhttps://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf
Dutch Transplantation FoundationNRYNRNRNRNRhttps://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie
Organización Nacional de Trasplantes YYYNRNNhttps://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf
NHS Blood and TransplantYYYNRNRNRhttps://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/
SwisstransplantYNRYNNNREnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
Latin AmericaBrazilian Association of Organ TransplantationNRNRNRNRNRNRhttp://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157
North AmericaAmerican Association For The Study Of Liver DiseasesYYYYNRNhttps://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf
American Society of Transplant SurgeonsNRNRNRYNRNhttps://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl
Canadian Blood Services and Canadian Society of TransplantationYYYYNYhttps://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services
Organ Procurement and Transplantation Network NRNRNRNRNRNRTTS.ORG- pdf Information for transplant programs
United Network for Organ Sharing/American Society for Transplantation NRNRNRNRNRNRhttps://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.

RegionInstitution1. Recommend excluding donors with documented COVID-19 infection?2. Recommend excluding donors with inconclusive COVID-19 screening?Website/Source of Information
InternationalThe International Society of Heart and Lung Transplantation YNRhttps://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf
International Liver Transplant SocietyNRNRhttps://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/
The Transplantation Society YYhttps://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140
AsiaIndian Society of TransplantationYNRhttps://isot.co.in/file/ISOT_COVID_V1_March_26.pdf
Korean Society for TransplantationNRNRhttp://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword=
AustralasiaAustralian Government Organ and Tissue Authority and The Transplantation Society of Australia and New ZealandYYhttps://www.tsanz.com.au/
EuropeEuropean Centre for Disease Prevention and ControlYNRhttps://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf
European Society of TransplantationNRNRhttps://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 NNRhttps://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf
Belgian Transplantation SocietyYNRhttps://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf
Dutch Transplantation Foundation YNRhttps://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie
Organización Nacional de Trasplantes YYhttps://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf
NHS Blood and TransplantYYhttps://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/
SwisstransplantYYEnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
Latin AmericaBrazilian Association of Organ TransplantationNRNRhttp://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157
North AmericaAmerican Association For The Study Of Liver DiseasesYNRhttps://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf
American Society of Transplant SurgeonsYNRhttps://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl
Canadian Blood Services and Canadian Society of TransplantationYNhttps://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services
Organ Procurement and Transplantation Network NRNRTTS.ORG - pdf Information for transplant programs
United Network for Organ Sharing/American Society for Transplantation NRNRhttps://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.”

RegionInstitutionRecommendation regarding exclusion of potential donors based on clinical criteria?Website/Source of Information
InternationalThe International Society of Heart and Lung Transplantation Yhttps://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf
International Liver Transplant SocietyNRhttps://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/
The Transplantation Society Yhttps://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140
AsiaIndian Society of TransplantationYhttps://isot.co.in/file/ISOT_COVID_V1_March_26.pdf
Korean Society for TransplantationNRhttp://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword=
AustralasiaAustralian Government Organ and Tissue Authority and The Transplantation Society of Australia and New ZealandYhttps://www.tsanz.com.au/
EuropeEuropean Centre for Disease Prevention and ControlNRhttps://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf
European Society of TransplantationYhttps://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 Nhttps://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf
Belgian Transplantation SocietyNRhttps://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf
Dutch Transplantation FoundationYhttps://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie
Organización Nacional de Trasplantes Yhttps://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf
NHS Blood and TransplantNhttps://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/
SwisstransplantYEnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
Latin AmericaBrazilian Association of Organ TransplantationNRhttp://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157
North AmericaAmerican Association For The Study Of Liver DiseasesYhttps://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf
American Society of Transplant SurgeonsNRhttps://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl
Canadian Blood Services and Canadian Society of TransplantationYhttps://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services
Organ Procurement and Transplantation Network YTTS.ORG - pdf Information for transplant programs
United Network for Organ Sharing/American Society for Transplantation NRhttps://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.

RegionInstitutionRecommendation regarding organs offered from other countries?Website/Source of Information
InternationalThe International Society of Heart and Lung Transplantation NRhttps://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf
International Liver Transplant SocietyNRhttps://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/
The Transplantation Society Yhttps://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140
AsiaIndian Society of TransplantationNRhttps://isot.co.in/file/ISOT_COVID_V1_March_26.pdf
Korean Society for TransplantationNRhttp://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword=
AustralasiaAustralian Government Organ and Tissue Authority and The Transplantation Society of Australia and New ZealandNRhttps://www.tsanz.com.au/
EuropeEuropean Centre for Disease Prevention and ControlNRhttps://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf
European Society of TransplantationNRhttps://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 NRhttps://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf
Belgian Transplantation SocietyYhttps://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf
Dutch Transplantation FoundationYhttps://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie
Organización Nacional de Trasplantes NRhttps://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf
NHS Blood and TransplantNRhttps://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/
SwisstransplantNEnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
Latin AmericaBrazilian Association of Organ TransplantationNRhttp://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157
North AmericaAmerican Association For The Study Of Liver DiseasesNRhttps://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf
American Society of Transplant SurgeonsNRhttps://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl
Canadian Blood Services and Canadian Society of TransplantationYhttps://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services
Organ Procurement and Transplantation Network NRTTS.ORG - pdf Information for transplant programs
United Network for Organ Sharing/American Society for Transplantation NRhttps://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.

RegionInstitutionRecommend testing regimen for documenting clearance of confirmed cases?Website/Source of Information
InternationalThe International Society of Heart and Lung Transplantation Yhttps://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf
International Liver Transplant SocietyNRhttps://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/
The Transplantation Society NRhttps://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140
AsiaIndian Society of TransplantationNRhttps://isot.co.in/file/ISOT_COVID_V1_March_26.pdf
Korean Society for TransplantationNRhttp://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword=
AustralasiaAustralian Government Organ and Tissue Authority and The Transplantation Society of Australia and New ZealandYhttps://www.tsanz.com.au/
EuropeEuropean Centre for Disease Prevention and ControlYhttps://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf
European Society of TransplantationNhttps://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 NRhttps://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf
Belgian Transplantation SocietyNhttps://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf
Dutch Transplantation FoundationNRhttps://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie
Organización Nacional de Trasplantes Yhttps://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf
NHS Blood and TransplantYhttps://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/
SwisstransplantYEnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
Latin AmericaBrazilian Association of Organ TransplantationNRhttp://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157
North AmericaAmerican Association For The Study Of Liver DiseasesYhttps://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf
American Society of Transplant SurgeonsYhttps://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl
Canadian Blood Services and Canadian Society of TransplantationYhttps://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services
Organ Procurement and Transplantation Network NRTTS.ORG - pdf Information for transplant programs
United Network for Organ Sharing/American Society for Transplantation Yhttps://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.

RegionInstitutionRecommend avoiding retrieval from donors within endemic/high prevalence areasWebsite/Source of Information
InternationalThe International Society of Heart and Lung Transplantation NRhttps://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf
International Liver Transplant SocietyYhttps://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/
The Transplantation Society Yhttps://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140
AsiaIndian Society of TransplantationNRhttps://isot.co.in/file/ISOT_COVID_V1_March_26.pdf
Korean Society for TransplantationNRhttp://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword=
AustralasiaAustralian Government Organ and Tissue Authority and The Transplantation Society of Australia and New ZealandNRhttps://www.tsanz.com.au/
EuropeEuropean Centre for Disease Prevention and ControlNRhttps://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf
European Society of TransplantationYhttps://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 NRhttps://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf
Belgian Transplantation SocietyNRhttps://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf
Dutch Transplantation FoundationNRhttps://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie
Organización Nacional de Trasplantes NRhttps://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf
NHS Blood and TransplantNRhttps://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/
SwisstransplantNREnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
Latin AmericaBrazilian Association of Organ TransplantationNRhttp://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157
North AmericaAmerican Association For The Study Of Liver DiseasesYhttps://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf
American Society of Transplant SurgeonsNRhttps://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl
Canadian Blood Services and Canadian Society of TransplantationNRhttps://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services
Organ Procurement and Transplantation Network NRTTS.ORG- pdf Information for transplant programs
United Network for Organ Sharing/American Society for Transplantation NRhttps://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.

RegionInstitutionRecommendation 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
InternationalThe International Society of Heart and Lung Transplantation YNRYYYhttps://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf
International Liver Transplant SocietyNRNRNRNRNRhttps://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/
The Transplantation Society NRNRNRNRNRhttps://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140
AsiaIndian Society of TransplantationYNRYNRNRhttps://isot.co.in/file/ISOT_COVID_V1_March_26.pdf
Korean Society for TransplantationNRNRNRNRNRhttp://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword=
AustralasiaAustralian Government Organ and Tissue Authority and The Transplantation Society of Australia and New ZealandYYNRNRNRhttps://www.tsanz.com.au/
EuropeEuropean Centre for Disease Prevention and ControlYNRNRNRNRhttps://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf
European Society of TransplantationNYNRNRNRhttps://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 NRNRNRNRNRhttps://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf
Belgian Transplantation SocietyYNRNRYNRhttps://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf
Dutch Transplantation SocietyYYNRNRNRhttps://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie
Organización Nacional de Trasplantes YYNRNRNRhttps://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf
NHS Blood and TransplantYYYNRNRhttps://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/
SwisstransplantYYYYYEnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
Latin AmericaBrazilian Association of Organ TransplantationYYYNRNRhttp://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157
North AmericaAmerican Association For The Study Of Liver DiseasesYYNRNNRhttps://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf
American Society of Transplant SurgeonsYNRNRNRNRhttps://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl
Canadian Blood Services and Canadian Society of TransplantationYYNRNRNRhttps://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services
Organ Procurement and Transplantation Network NRNRNRNRNRTTS.ORG website - pdf Information for transplant programs
United Network for Organ Sharing/American Society for Transplantation NRNRNRNRNRhttps://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.

RegionInstitutionRecommend 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
InternationalThe International Society of Heart and Lung Transplantation NRYYNRhttps://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf
International Liver Transplant SocietyYNRNRNRhttps://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/
The Transplantation Society YYNRYhttps://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140
AsiaIndian Society of TransplantationNRNRNRNRhttps://isot.co.in/file/ISOT_COVID_V1_March_26.pdf
Korean Society for TransplantationYNRNRNRhttp://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword=
AustralasiaAustralian Government Organ and Tissue Authority and The Transplantation Society of Australia and New ZealandNRNRNRYhttps://www.tsanz.com.au/
EuropeEuropean Centre for Disease Prevention and ControlNRNRNRNRhttps://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf
European Society of TransplantationNRNRNRNRhttps://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 NRNRNRNRhttps://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf
Belgian Transplantation SocietyNRNRNRNRhttps://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf
Dutch Transplantation FoundationNRNRYNRhttps://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie
Organización Nacional de Trasplantes NRYNRNRhttps://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf
NHS Blood and TransplantNRNNRYhttps://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/
SwisstransplantYYNRNREnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
Latin AmericaBrazilian Association of Organ TransplantationNRNRNRNRhttp://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157
North AmericaAmerican Association For The Study Of Liver DiseasesYYNRYhttps://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf
American Society of Transplant SurgeonsNRNRNRNRhttps://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl
Canadian Blood Services and Canadian Society of TransplantationNRNRNRNRhttps://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services
Organ Procurement and Transplantation Network NRNRNRNRTTS.ORG website - pdf Information for transplant programs
United Network for Organ Sharing/American Society for Transplantation NRNRNRNRhttps://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.

RegionInstitutionRecommend 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
InternationalThe International Society of Heart and Lung Transplantation NNNRYNNhttps://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf
International Liver Transplant SocietyNRNRNRNRNRNRhttps://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/
The Transplantation Society NRNRNRNRNRNRhttps://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140
International Society of Nephrologyhttps://www.theisn.org/covid19/recommendations
AsiaIndian Society of TransplantationNRNRYNRNRNRhttps://isot.co.in/file/ISOT_COVID_V1_March_26.pdf
Korean Society for TransplantationNRNRNRNRNRNRhttp://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword=
AustralasiaAustralian Government Organ and Tissue Authority and The Transplantation Society of Australia and New ZealandNRNRNRNRNRNRhttps://www.tsanz.com.au/
EuropeEuropean Centre for Disease Prevention and ControlNRNRNRNRNRNRhttps://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf
European Society of TransplantationNRNRNRNRNRNRhttps://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 NRNRNRNRNRNRhttps://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf
Belgian Transplantation SocietyNRNRNRNRNRNRhttps://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf
Dutch Transplantation FoundationNRNNRNNRNRhttps://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie
Organización Nacional de Trasplantes NRNRNRNRNRNRhttps://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf
NHS Blood and TransplantNRNRNRNRNRNRhttps://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/
SwisstransplantYYYYYYEnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
Latin AmericaBrazilian Association of Organ TransplantationNRNRNRNRNRNRhttp://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157
North AmericaAmerican Association For The Study Of Liver DiseasesNRNNRYYYhttps://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf
American Society of Transplant SurgeonsNRNNYNRNhttps://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl
Canadian Blood Services and Canadian Society of TransplantationNRNNYNNRhttps://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services
Organ Procurement and Transplantation Network NRNRNRNRNRNRTTS.ORG website - pdf Information for transplant programs
United Network for Organ Sharing/American Society for Transplantation NRNRNRNRNRNRhttps://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.

RegionInstitutionRecommendation 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
InternationalThe International Society of Heart and Lung Transplantation NRYYYYYhttps://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf
International Liver Transplant SocietyYNRYNRNRNRhttps://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/
The Transplantation Society NRYYNRNRNRhttps://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140
International Society of NephrologyN/AN/AN/AN/AN/AN/Ahttps://www.theisn.org/covid19/recommendations
AsiaIndian Society of TransplantationYYYNRNRNRhttps://isot.co.in/file/ISOT_COVID_V1_March_26.pdf
Korean Society for TransplantationYYNRNRNRNRhttp://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword=
AustralasiaAustralian Government Organ and Tissue Authority and The Transplantation Society of Australia and New ZealandNRNRNRNRNRNRhttps://www.tsanz.com.au/
EuropeEuropean Centre for Disease Prevention and ControlNRNRNRYNRNRhttps://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf
European Society of TransplantationYYNRNRNRNRhttps://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 NRNRNRNRNRNRhttps://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf
Belgian Transplantation SocietyNRYNRYNRNRhttps://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf
Dutch Transplantation FoundationNRNRYYYNRhttps://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie
Organización Nacional de Trasplantes NRNRNRNRNRNRhttps://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf
NHS Blood and TransplantYNRYNRNRNRhttps://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/
SwisstransplantYYNYNNEnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
Latin AmericaBrazilian Association of Organ TransplantationNRYYNRNRNhttp://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157
North AmericaAmerican Association For The Study Of Liver DiseasesYYYYNRNRhttps://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf
American Society of Transplant SurgeonsNRNRNRNRNRNRhttps://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl
Canadian Blood Services and Canadian Society of TransplantationNRNRNRNRNRNRhttps://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services
Organ Procurement and Transplantation Network NRNRNRNRNRNRTTS.ORG website - pdf Information for transplant programs
United Network for Organ Sharing/American Society for Transplantation NRYYYNRYhttps://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.

RegionInstitutionRecommendation 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
InternationalThe International Society of Heart and Lung Transplantation NRNRNRNRNRhttps://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf
International Liver Transplant SocietyNRNRNRNRNRhttps://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/
The Transplantation SocietyNRYNRNRYhttps://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140
International Society of NephrologyN/AN/AN/AN/AN/Ahttps://www.theisn.org/covid19/recommendations
AsiaIndian Society of TransplantationYYNRNRNRhttps://isot.co.in/file/ISOT_COVID_V1_March_26.pdf
Korean Society for TransplantationNRNRNRNRNRhttp://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword=
AustralasiaAustralian Government Organ and Tissue Authority and The Transplantation Society of Australia and New ZealandNRNRNRNRYhttps://www.tsanz.com.au/
EuropeEuropean Centre for Disease Prevention and ControlNRNRNRNRNRhttps://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf
European Society of TransplantationNRYNRNRNRhttps://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 NRNRNRNRNRhttps://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf
Belgian Transplantation SocietyNRNRNRNRNRhttps://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf
Dutch Transplantation FoundationYYYYNRhttps://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie
Organización Nacional de Trasplantes NRNRNRNRNRhttps://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf
NHS Blood and TransplantYYNRYNRhttps://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/
SwisstransplantYYNYNREnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
Latin AmericaBrazilian Association of Organ TransplantationYYNRNRNRhttp://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157
North AmericaAmerican Association For The Study Of Liver DiseasesNRYYYYhttps://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf
American Society of Transplant SurgeonsNRNRNRNRNRhttps://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl
Canadian Blood Services and Canadian Society of TransplantationNRNRNRNRNRhttps://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services
Organ Procurement and Transplantation Network NRNRNRNRNRTTS.ORG website - pdf Information for transplant programs
United Network for Organ Sharing/American Society for Transplantation YNRNRNRYhttps://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.

RegionInstitutionRecommendation on suspension of deceased kidney/pancreas donation?Website/Source
InternationalThe International Society of Heart and Lung Transplantation NRhttps://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf
International Liver Transplant SocietyNRhttps://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/
The Transplantation Society Yhttps://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140
AsiaIndian Society of TransplantationNRhttps://isot.co.in/file/ISOT_COVID_V1_March_26.pdf
Korean Society for TransplantationNRhttp://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword=
AustralasiaAustralian Government Organ and Tissue Authority and The Transplantation Society of Australia and New ZealandNRhttps://www.tsanz.com.au/
EuropeEuropean Centre for Disease Prevention and ControlNRhttps://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf
European Society of TransplantationYhttps://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 Yhttps://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf
Belgian Transplantation SocietyYhttps://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf
Dutch Transplantation FoundationNhttps://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie
Organización Nacional de Trasplantes NRhttps://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf
NHS Blood and TransplantNhttps://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/
SwisstransplantNREnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
Latin AmericaBrazilian Association of Organ TransplantationYhttp://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157
North AmericaAmerican Association For The Study Of Liver DiseasesNRhttps://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf
American Society of Transplant SurgeonsNRhttps://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl
Canadian Blood Services and Canadian Society of TransplantationNhttps://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services
Organ Procurement and Transplantation Network NRTTS.ORG - pdf Information for transplant programs
United Network for Organ Sharing/American Society for Transplantation NRhttps://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.

RegionInstitutionRecommendation on suspension of deceased liver donation?Recommend alteration of deceased liver organ donation and transplantation?Website/Source of Information
InternationalThe International Society of Heart and Lung Transplantation NRNRhttps://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf
International Liver Transplant SocietyNRNRhttps://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/
The Transplantation Society YNRhttps://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140
AsiaIndian Society of TransplantationNRNRhttps://isot.co.in/file/ISOT_COVID_V1_March_26.pdf
Korean Society for TransplantationNRNRhttp://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword=
AustralasiaAustralian Government Organ and Tissue Authority and The Transplantation Society of Australia and New ZealandNRNRhttps://www.tsanz.com.au/
EuropeEuropean Centre for Disease Prevention and ControlNRNRhttps://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf
European Society of TransplantationYNRhttps://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 YNRhttps://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf
Belgian Transplantation SocietyYYhttps://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf
Dutch Transplantation FoundationNNRhttps://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie
Organización Nacional de Trasplantes NNhttps://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf
NHS Blood and TransplantNNRhttps://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/
SwisstransplantNNEnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
Latin AmericaBrazilian Association of Organ TransplantationYNRhttp://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157
North AmericaAmerican Association For The Study Of Liver DiseasesNNhttps://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf
American Society of Transplant SurgeonsNRNRhttps://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl
Canadian Blood Services and Canadian Society of TransplantationNRNRhttps://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services
Organ Procurement and Transplantation Network NRNRTTS.ORG website - pdf Information for transplant programs
United Network for Organ Sharing/American Society for Transplantation NRNRhttps://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.

RegionInstitutionRecommendation 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
InternationalThe International Society of Heart and Lung Transplantation NYYYhttps://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf
International Liver Transplant SocietyNRNRNRNRhttps://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/
The Transplantation Society YNRNRNRhttps://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140
AsiaIndian Society of TransplantationNRNRNRNRhttps://isot.co.in/file/ISOT_COVID_V1_March_26.pdf
Korean Society for TransplantationNRNRNRNRhttp://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword=
AustralasiaAustralian Government Organ and Tissue Authority and The Transplantation Society of Australia and New ZealandNRNRNRNRhttps://www.tsanz.com.au/
EuropeEuropean Centre for Disease Prevention and ControlNRNRNRNRhttps://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf
European Society of TransplantationYYYYhttps://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 NRYYNRhttps://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf
Belgian Transplantation SocietyNYYYhttps://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf
Dutch Transplantation FoundationNNRNNhttps://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie
Organización Nacional de Trasplantes NNNNhttps://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf
NHS Blood and TransplantNNNNhttps://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/
SwisstransplantNYYYEnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
Latin AmericaBrazilian Association of Organ TransplantationNRNRNRNRhttp://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157
North AmericaAmerican Association For The Study Of Liver DiseasesNRNRNRNRhttps://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf
American Society of Transplant SurgeonsNRNRNRNRhttps://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl
Canadian Blood Services and Canadian Society of TransplantationNRNRNRNRhttps://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services
Organ Procurement and Transplantation Network NRNRNRNRTTS.ORG website - pdf Information for transplant programs
United Network for Organ Sharing/American Society for Transplantation NRNRNRNRhttps://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.

RegionInstitutionRecommend 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
InternationalThe International Society of Heart and Lung Transplantation NRNRNRNRNRNRNRNRhttps://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf
International Liver Transplant SocietyNRNRNRYNRNRNRNRhttps://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/
The Transplantation Society YYYYNNRNRNRhttps://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140
AsiaIndian Society of TransplantationYYYNRYNRNRNRhttps://isot.co.in/file/ISOT_COVID_V1_March_26.pdf
Korean Society for TransplantationNNYYYNRNRNR
AustralasiaAustralian Government Organ and Tissue Authority and The Transplantation Society of Australia and New ZealandNRNRNRNRYYNRNRhttps://www.tsanz.com.au/
EuropeEuropean Centre for Disease Prevention and ControlNRNRNRYYNRNRNRhttps://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf
European Society of TransplantationNRNRNRNRNRNRNRNRhttps://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 NNRYNRNRNRNRNRhttps://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf
Belgian Transplantation SocietyYNRNRNRNRNRNRNRhttps://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf
Dutch Transplantation FoundationYYYNRNRNRNRNRhttps://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie
Organización Nacional de Trasplantes NNYNYYNRNRhttps://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf
NHS Blood and TransplantNRNRYNRNYYNRhttps://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/
SwisstransplantNNYYYYYNREnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
Latin AmericaBrazilian Association of Organ TransplantationNRNRNRNRNRNRNRNRhttp://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157
North AmericaAmerican Association For The Study Of Liver DiseasesNNYYYYYYhttps://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf
American Society of Transplant SurgeonsNNYNRYNRNRNRhttps://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl
Canadian Blood Services and Canadian Society of TransplantationNNYYYYYYhttps://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services
Organ Procurement and Transplantation Network NRNRNRNRNRNRNRNRTTS.ORG website - pdf Information for transplant programs
United Network for Organ Sharing/American Society for Transplantation NRNRNRNRNRNRNRNRhttps://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.

RegionInstitution1. Include Recommendations for ODT professionals' PPE Use2. Recommend following hospital procedures when in contact with COVID-19 + or suspected patients3. Recommend application of routine surgical masks and gloves for all patient encounters4. 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
InternationalThe International Society of Heart and Lung Transplantation YNRNRYYNRhttps://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf
International Liver Transplant SocietyYNRNRNRNRNRhttps://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/
The Transplantation Society NRNRNRNRNRNRhttps://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140
AsiaIndian Society of TransplantationYYNRNRYNRhttps://isot.co.in/file/ISOT_COVID_V1_March_26.pdf
Korean Society for TransplantationYYYNRYNRhttp://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword=
AustralasiaAustralian Government Organ and Tissue Authority and The Transplantation Society of Australia and New ZealandYNRNRNRNRNRhttps://www.tsanz.com.au/
EuropeEuropean Centre for Disease Prevention and ControlYNRNRNRYNRhttps://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf
European Society of TransplantationNRNRNRNRNRNRhttps://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 NRNRNRNRNRNRhttps://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf
Belgian Transplantation SocietyNRNRNRNRNRNRhttps://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf
Dutch Transplantation FoundationYNRNRNRNRNRhttps://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie
Organización Nacional de Trasplantes NRNRNRNRNRNRhttps://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf
NHS Blood and TransplantYYNNYNRhttps://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/
SwisstransplantYYYYNNEnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
Latin AmericaBrazilian Association of Organ TransplantationNRNRNRNRNRNRhttp://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157
North AmericaAmerican Association For The Study Of Liver DiseasesYYYYYYhttps://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf
American Society of Transplant SurgeonsNRNRNRNRNRNRhttps://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl
Canadian Blood Services and Canadian Society of TransplantationYYYYYNRhttps://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services
Organ Procurement and Transplantation Network NRNRNRNRNRNRTTS.ORG website - pdf Information for transplant programs
United Network for Organ Sharing/American Society for Transplantation YYYYNRNRhttps://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.

RegionInstitution1. 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 benefit4. Recommends ensure recipient is available for organs prior to initiationWebsite/Source of Information
InternationalThe International Society of Heart and Lung Transplantation YYNRNRhttps://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf
International Liver Transplant SocietyNRNRNRNRhttps://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/
The Transplantation Society NRYNRNRhttps://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140
AsiaIndian Society of TransplantationYNRNRNRhttps://isot.co.in/file/ISOT_COVID_V1_March_26.pdf
Korean Society for TransplantationNRNRNRNRhttp://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword=
AustralasiaAustralian Government Organ and Tissue Authority and The Transplantation Society of Australia and New ZealandNRNRNRNRhttps://www.tsanz.com.au/
EuropeEuropean Centre for Disease Prevention and ControlNRNRNRNRhttps://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf
European Society of TransplantationNRNRNRNRhttps://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 YNRNRNRhttps://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf
Belgian Transplantation SocietyNRNRYYhttps://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf
Dutch Transplantation FoundationNRNRYNRhttps://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie
Organización Nacional de Trasplantes NRNRNRNRhttps://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf
NHS Blood and TransplantYYYNRhttps://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/
SwisstransplantYYYYEnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
Latin AmericaBrazilian Association of Organ TransplantationNRNRNRNRhttp://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157
North AmericaAmerican Association For The Study Of Liver DiseasesYYYYhttps://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf
American Society of Transplant SurgeonsNRNRNRNRhttps://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl
Canadian Blood Services and Canadian Society of TransplantationYNRNRNRhttps://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services
Organ Procurement and Transplantation Network NRNRNRNRTTS website - pdf Information for transplant programs
United Network for Organ Sharing/American Society for Transplantation NRNRNRNRhttps://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.

RegionInstitution1. Recommends ensure recipient is available for organs prior to initiation2. 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
InternationalThe International Society of Heart and Lung Transplantation NRYNRNRYNRNRhttps://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf
International Liver Transplant SocietyNRNRNRNRNRNRNRhttps://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/
The Transplantation Society NRNRNRNRNRNRYhttps://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140
AsiaIndian Society of TransplantationNRNRYNRNRNRNRhttps://isot.co.in/file/ISOT_COVID_V1_March_26.pdf
Korean Society for TransplantationNRNRNRNRNRNRNRhttp://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword=
AustralasiaAustralian Government Organ and Tissue Authority and The Transplantation Society of Australia and New ZealandNRNRNRNRNRNRNRhttps://www.tsanz.com.au/
EuropeEuropean Centre for Disease Prevention and ControlNRNRYNRNRNRNRhttps://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf
European Society of TransplantationNRNRNRNRNRNRNRhttps://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 NRNRNRNRNRNRNRhttps://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf
Belgian Transplantation SocietyYYNRNRNRNRNRhttps://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf
Dutch Transplantation FoundationNRYYNRNRNRNRhttps://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie
Organización Nacional de Trasplantes NRNRNRNRNRNRNRhttps://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf
NHS Blood and TransplantNRNRYNRNRNRNRhttps://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/
SwisstransplantNRYYYYNNEnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
Latin AmericaBrazilian Association of Organ TransplantationNRNRNRNRNRNRNRhttp://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157
North AmericaAmerican Association For The Study Of Liver DiseasesYNRYNRYNRNRhttps://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf
American Society of Transplant SurgeonsNRNRNRNRNRNRNRhttps://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl
Canadian Blood Services and Canadian Society of TransplantationNRYNRNRNRNRNRhttps://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services
Organ Procurement and Transplantation Network NRNRNRNRNRNRNRTTS website - pdf Information for transplant programs
United Network for Organ Sharing/American Society for Transplantation NRNRNRNRNRNRNRhttps://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.

RegionInstitutionsRecommendation 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-19Recommendation on number of patients in a room?Website/Source of Information
InternationalThe International Society of Heart and Lung Transplantation YYNNYNRhttps://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf
International Liver Transplant SocietyNRNRNRNRNRNRhttps://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/
The Transplantation Society YYYYNRNRhttps://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140
AsiaIndian Society of TransplantationYYNRNRNRNRhttps://isot.co.in/file/ISOT_COVID_V1_March_26.pdf
Korean Society for TransplantationNRNRNRNRYNRhttp://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword=
AustralasiaAustralian Government Organ and Tissue Authority and The Transplantation Society of Australia and New ZealandNRNRNRNRNRNRInternational Dropbox
EuropeEuropean Centre for Disease Prevention and ControlNRNRNRNRNRYhttps://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf
European Society of TransplantationNRNRNRNRNRNRhttps://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 NRNRNRNRNRNRhttps://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf
Belgian Transplantation SocietyNRNRNRNRNRNRhttps://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf
Dutch Transplantation FoundationYYNRNRNRNRhttps://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie
Organización Nacional de Trasplantes NRNRNRNRNRNRhttps://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf
NHS Blood and TransplantYYNNRYYhttps://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/
SwisstransplantYNYNYNEnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
Latin AmericaBrazilian Association of Organ TransplantationNRNRNRNRNRNRhttp://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157
North AmericaAmerican Association For The Study Of Liver DiseasesYYYNRNRYhttps://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf
American Society of Transplant SurgeonsNRNRNRNRNRNRhttps://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl
Canadian Blood Services and Canadian Society of TransplantationNRNRNRNRNRNRhttps://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services
Organ Procurement and Transplantation Network NRNRYNRNNRTTS website - pdf Information for transplant programs
United Network for Organ Sharing/American Society for Transplantation NRNRNRNRNRNRhttps://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.

RegionInstitutionRecommend 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
InternationalThe International Society of Heart and Lung Transplantation YYYhttps://ishlt.org/ishlt/media/documents/SARS-CoV-2_-Guidance-for-Cardiothoracic-Transplant-and-VAD-centers.pdf
International Liver Transplant SocietyNRNRNRhttps://ilts.org/covid-19-statement-from-the-infectious-diseases-and-liver-transplantation-sig/
The Transplantation Society YYYhttps://tts.org/index.php?option=com_content&view=article&id=749&Itemid=140
AsiaIndian Society of TransplantationNRNRNRhttps://isot.co.in/file/ISOT_COVID_V1_March_26.pdf
Korean Society for TransplantationNRNRNRhttp://www.mykst.org/board/list.html?num=700&start=0&sort=top%20desc,reg_dt%20desc&code=m_notice&key=&keyword=
AustralasiaAustralian Government Organ and Tissue Authority and The Transplantation Society of Australia and New ZealandNRNRNRhttps://www.tsanz.com.au/
EuropeEuropean Centre for Disease Prevention and ControlNRNRNRhttps://www.ecdc.europa.eu/sites/default/files/documents/covid-19-supply-substances-human-origin.pdf
European Society of TransplantationNRNRNRhttps://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 NRNRNRhttps://content.tts.org/content/covid19/france-Agency-of-the-Biomedicine.pdf
Belgian Transplantation SocietyNRNRNRhttps://www.eurotransplant.org/wp-content/uploads/2020/04/BTS-position-paper_ET-letter.pdf
Dutch Transplantation FoundationYYYhttps://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie
Organización Nacional de Trasplantes NRNRNRhttps://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf
NHS Blood and TransplantYYYhttps://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/
SwisstransplantNRNRNREnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
Latin AmericaBrazilian Association of Organ TransplantationYNNhttp://www.abto.org.br/abtov03/default.aspx?mn=476&c=0&s=157
North AmericaAmerican Association For The Study Of Liver DiseasesYYNRhttps://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf
American Society of Transplant SurgeonsNRNRNRhttps://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl
Canadian Blood Services and Canadian Society of TransplantationYYYhttps://professionaleducation.blood.ca/en/organs-and-tissues/covid-19-update-organ-donation-and-transplantation-services
Organ Procurement and Transplantation Network NRNRNRTTS website - pdf Information for transplant programs
United Network for Organ Sharing/American Society for Transplantation YYYhttps://www.myast.org/covid-19-information
https://unos.org/covid/