Mandatory for all potential donors.
All patients in regions where SARS-CoV-2 is circulating should be tested for virus prior to transplantation, even if asymptomatic.
Candidates should be educated about preventive strategies such as social distancing, masking when in proximity to non-household contacts and frequent hand washing.
Temporary suspension of elective living donor transplantation may need to be considered.
To counsel all living donors for: self-quarantining; frequent hand washing; maintaining social distance if out in public; and mask or face covering if out in public.
They recommend use of face masks, eye protection and and N95 masks (for professionals who enter the room of a patient with known or suspected COVID-19 or as specified by institutional policies) and while they remain available.
If testing is not available for deceased donors (intermediate risk), we recommend NOT transplanting lungs or intestines. The decision to transplant other organs should be made with caution after careful consideration of the risks and benefits.
Must be thoroughly screened; more manageable with living donor.
As with the live donor, a negative COVID-19 PCR, self-isolation for 7-14 days followed by a pre-procedure negative PCR, CXR, and normal exam will provide support that the transplant procedure is performed on an uninfected individual.
We would propose that a medically suitable, COVID-19 PCR- donor with no history of cough or exposures go into self-isolation for a minimum of 7 days, but preferably 7-14 days. Two days prior to proposed donation, another COVID-PCR should be negative, and on the day of surgery a rapid COVID-19 PCR, temperature check, and CXR should be normal.
Acknowledges that significant false negative rate, so must use all information at disposal when making a decision.
Regardless of test outcome, serisously consider not accepting from donor with « recent history of suspicious febrile or respiratory illness and/or chest CT with ground glass infiltrates ».
Other countries not mentioned. However, strongly encouraged local retrieval and shipment to recipient team. Highly recommend against travel.
Must consider recent symptoms and environment.
PCR test on BAL is preference, though must consider risk of aerosols.
Second best to BAL.
Consider notifying patients that the COVID-19 pandemic may impact their waiting time on the transplant list; Notify patients that family and visitor access to them during their hospital stay may be limited or prohibited.
SARS-CoV-2-positive transplant candidates may be considered for transplantation at least 14-21 days after symptom resolution and 1 or 2 negative SARS-CoV-2 diagnostic tests.
Document does not delineate b/w deceased and living donors, but certainly recommends screening all potential donors for COVID symptoms, as the test can provide false negatives.
Recommend limiting face-to-face interactions as much as possible, including on patient rounds post-transplant; only include trainees and fellows when adequate PPE available.
The American Gastroenterological Association recommend healthcare workers involved with endoscopy wear a full set of PPE, including N95 masks and double gloves.
Pre and early post transplant patients to be cared for in single rooms in COVID-19 free wards, when possible.
Duration of enhanced social distancing pre- and post-donation must be in line with national guidance.
Both recipient and live donor are tested at time of assessment and prior to surgery via swab (must test negative 48-72 hours before planned procedure).
Increased number of vehicles for transport to increase distance between staff. Masks to be worn when social distancing impossible. Anticipate absenteeism for various reasons. Encourage telemedicine, home delivery of immunosuppression, and rescheduling of non-urgent appointments.
Only if not recovered; if recovered, carefully assessed after 28 days or be subject to clinical assessment and multidisciplinary discussion.
Some units have used chest CT to screen potential transplant recipients, but have been largely replaced by nose and throat swabs due to false negative and false positive results concerns.
Unfortunately, no more than one visitor at a time may come to the hospital per patient.
Patients will be tested for COVID-19 just before the transplant. They must take medicines immediately after a transplant to prevent their body from rejecting the new organ. The immune system is therefore much less, and they can become seriously ill from the coronavirus.
The operation team only goes to a hospital where patients with corona are in isolation.
Liver donation programs have been maintained since the beginning of COVID-19.
Use of organs from COVID-19+ donors to be considered on case by case basis and depends on organ.
All potential donors tested by PCR. Paediatric transplantation continue without restriction.
A country with widespread community transmission, temporary suspension of the deceased donor program should be considered, especially when resources at the transplant centre may be constrained.
Consider reduced frequencies of clinic visits and laboratory testing.
Have a plan for physician and staff absences or furloughs due exposure to patients with or team member illness with COVID-19.
Should not be performed on either a donor or recipient who has returned from countries with >10 infected patients or who have been exposed to a patient with confirmed or suspected COVID-19 within 14 days.
Serology assays (IgG and IgM) are becoming available. They have higher sensitivity later in
the course of disease. Their potential utility in donor screening has not been evaluated.
The utility of CT chest screening in this setting is unknown but could provide added information especially for lung transplantation » « There is limited data on sensitivity and specificity in the setting of donor screening. CT chest has good sensitivity in patients with symptoms, but has lower sensitivity in asymptomatic individuals. The sensitivity and specificity in deceased donors is not known.
All potential donors must be tested for COVID-19.
We decided this because the recipient of a kidney receives a higher dose of immunosuppressive medicines around the operation. These patients may be extra vulnerable to (and side) infections. The safety of our patients is a priority. That is why we do not want to take extra risk, as long as the exact impact is still unclear at this time.
Recommend avoiding grouping of patients for education or clinical activities.
Ensure that all wait-listed or transplanted patients can adhere to social distance protocols in clinics or hospital.
Recommend temperature screening of all patients seen in clinic.
Recommend screening and self-isolation after travel as per local practice and protocols.
Recently transplanted patients should follow respiratory principle and wear a mask when available.
Recommend developing guidance for candidates and recipients about risk mitigation, including but not limiting exposure to large crowds, hand hygiene and avoidance of sick exposures.
Consider postponement of routine visits and surveillance.
Postpone all non-essential surveillance of wait-listed patients.
Recommend only seeing critical patients and defer routine surveillance visits.
Develop messaging for candidates and recipients abut how and when to contact the transplant centre in case of illness.
Encourage working from home (and supporting medical justification if needed), eliminate non-essential travel, hand hygiene, general social distancing.
Limit all non-essential contact and recommend increased use of distance consultation.
Detailed recommendations on how to favour remote evaluation (telephone or videoconferencing).
Follow-up with various means like mobile and email.
1) Postponing routine surveillance heart biopsies and bronchoscopies in patients that are more than 3-6 months from transplantation. 2) Increased importance of home as opposed to hospital based spirometry. 3) for heart recipients, suggest considering the use of non-invasive methods for rejection surveillance, as available such as gene expression profiling.
Potential and actual transplant recipients are by definition an at-risk population.
Acknowledge that exact risk is unknown but very likely increased compared to general population.
At risk of developing severe COVID-19; counsel recipient and family as high-risk.
Recommend a combination of tele-practice, pre-visit screening calls and limiting visits further if patient has COVID-19 consistent symptoms ISHLT.
Consider airborne precautions for recipient if donor had negative testing but epidemiological risk factors.
Should be housed in single rooms with an attached bathroom and all staff attending to them should be in full PPE until infection with COVID-19 is ruled out.
Suspended need for post-transplant follow-up reporting back dated to March 13 declaration of emergency. Also have created new data fields for COVID-19 related refusals of organs.
Recommend confirmation of blood product supply, ventilators and PPE prior to acceptance.
In geographically confined outbreaks, transplant authorities may consider putting transplant candidates on the waiting list at alternative centres for transplantation.
Centre should not be earmarked for the treatment of COVID-19 patients and needs to have protocols for patient movement around the hospital to prevent nosocomial acquisition of COVID.
Apply restrictions in travel for procurement and shipment of organs according to the policies decided by public authorities in the different ET member countries during the epidemic.
Whenever possible, recover organs locally and ship them. For those centres that cannot recover organs locally, the decision to send a surgical team can be assessed on case-by-case basis, relative to recipient urgency.
Screen and test.
Procurement activity has to be planned depending on the locally available resources and ideally by identifying at least one recipient for the organs to be procured ahead of the procedure. Programs should avoid procurement procedures for which subsequently no recipient is found.
All programs assess program specific risk/benefit analyses in devising their own unique additions for the benefit of their staff and patients.
With all this, the benefit of transplantation as compared to the risk of severe COVID infection is therefore difficult to assess and likely to evolve to the detriment of transplantation in the course of a worsening epidemic.
Must consider all resources for entirety of transplant pathway.
The transplant team must evaluate each organ offer for the specific potential recipient in light of resource availability and total course, prior to deciding whether to proceed with transplant. Specific mention of likely shortage of blood and blood products.
Consideration for all donors that have – COVID-19 screening test. ICU capacity to maintain donor or treat recipient is at discretion of ICU consultant (most responsible physician).
State that all transplantation should be done on a case by case balancing ICU resources, risk to patient and risk of immunosuppression.
Recommendations must balance the incidence trends in provinces and territories, the risk posed to potential recipients who will become immunocompromised, and the risks of suspending or delaying transplantation.
If donor had inconclusive or unavailable testing results, informed consent with potential recipient on unknown risk of transmission and lack of currently approved therapies.
Recommend informing all parties of risks during « uncertain times ».
If living donation from a COVID-19 + donor deemed medically necessary, explicit informed consent required for both donor and recipient. Deceased donation: If a graft from a donor with unknown COVID-19 status used, must have explicit informed consent from recipient.
For emergency lifesaving transplantation: appropriate counselling of both the donor and recipient as well as their families should be done, and a high-risk informed consent taken before proceeding with the transplant.
If transplantation is required as a life-saving procedure, it can be conducted with appropriate assessment of infection in door and recipient and with appropriate informed consent.
Regardless of donor screening, the centre should have a discussion of risk-benefit with the recipient.
Recipients of solid organ transplants should be fully informed at time of organ offer of the potential risk of severe complications should they contract the virus at the time of transplant, during the hospital stay, or once discharged from the hospital while being immunosuppressed. This informed consent should be clearly documented in the hospital chart.
To the extent feasible off-site, remote working and social distancing is prudent.
Recommend limiting face-to-face interactions as much as possible, including on patient rounds post-transplant.
Encourage videoconferencing even within the same building and alterations in catering practices.
Staff involved in care of transplant patients may not be involved in case of other patients.
Determine who can work remotely and ensure they have the resources to do so.
If surgical recovery teams travel, the teams should be as small as possible. Every effort should also be made to minimize the team’s potential exposure to COVID-19. For example, upon arrival in locality, teams should go directly to the OR, they should avoid the emergency department whenever possible, and they should return directly to the plane as soon as they are able.
Respiratory caution for all of us and respiratory barrier protection for healthcare workers should be incorporated into ALL transplant program protocols.
Recommend continuing with hospital procedures for OR PPE use for COVID-19 negative patients (all donors screened).
Bronchoscopy in cases of suspected COVID-19 or in areas where community transmission is occurring should be done using airborne isolation precautions.
N95 masks should be required for all ICU and OR staff, when deemed appropriate by
hospital safety protocols (e.g., procedures that may lead to aerosolization of the virus such
as intubation, bronchoscopy, surgical cautery, bone saw).
We suggest all health care professionals deploy routine universal precautions (surgical masks, gloves) during the care of COVID-negative donors and recipients. » « acknowledged that there is regional and institutional variability with respect to: i) COVID-specific PPE ii) Universal precautions iii) No routine precautions.
Strict isolation precautions should be followed for anyone with suspected SARS-CoV2.
It is important to follow local protocols for suspected patient infections.
Staff who have returned from countries with >10 infected patients or have been exposed to a confirmed or suspected case of COVID-19 within the last 14 days should follow hospital policies, but should likely not care for transplant patients.
Use airborne and contact precautions with face shield when entering the patient room with suspected + case.
Strong recommendation to follow national guidance adapted to local conditions.
Adhere to local protocols.
During the donation process medical staff should apply appropriate and hygiene and use personal protective
equipment in accordance with national public health guidelines [61,62]. Personal protective measures in the
donation area of a SoHO establishment which is not located in a hospital environment should not be as
stringent as in settings where staff take care of infected or potentially infected patients. Infection control
practices and measures should be in line with the national public health recommendations for COVID-19
Unless COVID-19 is suspected on epidemiological or clinical grounds, additional precautions to those usually employed for acquiring respiratory samples in standard, non-COVID-19 ICU patients is NOT required. Specifically, there is no need for patient isolation or the use of non-standard ICU PPE in ongoing care of these patients.
… »has to be adequate availability of PPE for care of these patients »
« Full PPE » as per local protocol when in contact with confirmed or suspected COVID-19 + patient.
General hygiene ( frequent hand washing, disinfect surfaces, avoid hand-face contact), avoidance, N95 and eye protection when in close contact.
Adhere to the CDC’s recommendations on PPE.
Suspension of all living donation.
Evaluated on a case by case basis. NHSBT must be informed when deceased donor or living donor transplant programmes are re-started.
All living-donor kidney transplantation and deceased donor transplantation in patients that are stable on dialysis are put on hold until the end of the COVID-19 epidemic.
Minimum of 6 weeks (effective Mar 16).
Advised to practice social distancing and not travel 14 days prior to surgery.
Recommend 28 days past resolution of symptoms and negative testing prior to consideration for use.
Two negative tests before being considered for donation and another negative test at the time of donation.
All living donors should have an upper respiratory sample.
Same as for deceased donors. PCR diagnostics must have been carried out on all living donors prior to organ removal to exclude the possibility of COVID-19 infection. If the PCR test on the living donor is positive, the organ removal must not be carried out.
Testing no longer than 7 days before donation.
Exclude if testing positive.
Where available, testing of upper and lower airway specimens by PCR/NAT of donors with concern for COVID-19 should be considered.
Testing occurring as close as possible prior to donation (within 24–48 hours). Current data suggests the optimal test type in this ambulatory setting is a nasopharyngeal swab.
Delay for 14 days.
21 days from travel to endemic area or contact with confirmed case.
At least 14 days after contact with COVID-19 positive or travel to region with sustained community transmission.
Exclusion if international travel in last 14 days or contact in last 14 days with confirmed case of COVID-19.
If donor has been within an endemic area, wait at least 14 days (presumed incubation period) for symptom development.
The living donor transplant programme may be temporarily suspended…all elective live living kidney and liver transplant should be postponed.
14 days after international travel.
Living donors are classified into high, intermediate and low risk based on testing, clinical signs and epidemiological factors.
Defer regardless of symptoms.
Question all potential donors for potential febrile respiratory symptoms or contact with COVID-19 suspected persons in 28 days prior to donation.
Donors should not be utilized if they have fever and/or respiratory symptoms unless SARS-CoV-2 is excluded.
Exclude if history of fever or acute respiratory infection (eg. Shortness of breath, cough, sore throat) with or without fever.
Donors should not be utilized if they have fever and/or respiratory symptoms unless SARS-COV-2 is excluded.
All potential living donors should undergo a symptom screen prior to donation. Any donor with compatible symptoms should be deferred but should also be tested to allow for future planning.
During periods of local transmission, temporary suspension of elective living donor Tx may need to be considered to protect the potential donor as well as the recipient.
Except for medical emergencies (e.g. pediatric acute liver failure).
In countries with widespread community transmission, temporary suspension of the living-donor kidney and liver transplant programs should be considered when donation can safely be deferred to a later date.
« Liver donor liver transplantation caries greater urgency…should continue on a case-by-case basis, taking into account recipient medical need and hospital resource utilization depending on the severity of the pandemic in the local jurisdiction. »
Recommend suspension until COVID-19 epidemiology better understood in US.
Evaluated on a case by case basis.
Program was suspended but the decision now is to start the program in phases (nephrologists have been given guides to slowly start again).
Normal, careful activity for COVID-19 negative donors and recipients. Caution kidney transplant resumption.
« All living donor kidney transplant programs in Canada should consider postponing living
donor transplants on a case-by-case basis and/or until this issue has resolved. »
Recommend continued life-saving transplantation on case-by-case basis.
All pulmonary centres are open, though some patients are concerned and have « self suspended ».
The hospitals that transplant hearts and lungs strive to carry out heart and lung transplants.
In a country with widespread community transmission, temporary suspension of the deceased donor program should be considered, especially when resources at the transplant centre may be constrained. There is no clear reason to suspend deceased donor transplants in countries only experiencing sporadic cases of COVID-19 cases.
Liver, heart, and lung transplantation programs continue. As a general guideline, priority should be given to hyper-urgent and urgent transplants.
No transplantation of lungs from COVID-19 + donors.
All heart centres are open and operating similarly to pre-COVID-19 numbers.
Consider transplantation from COVID-19 + donors on case by case basis, continue donation as usual if COVID-19 negative.
Decision must be made on case by case basis considering local resources and transmission risk.
As a general guideline, transplantation that are not lifesaving in the short term should be delayed until the end of the COVID epidemic. Liver, heart, and lung transplantation programs continue. As a general guideline, priority should be given to hyper-urgent and urgent transplants.
In a country with widespread community transmission, temporary suspension of the deceased donor program should be considered, especially when resources at the transplant centre may be constrained.
We do not recommend a general cessation of all transplant or VAD activity due to the COVID-19 pandemic solely to liberate resources for treating COVID-19 patients.
As a general guideline, transplantation that are not lifesaving in the short term should be delayed until the end of the COVID epidemic. At that stage, liver, heart, and lung transplantation programs continue. As a general guideline, priority should be given to hyper-urgent and urgent transplants.
Consider suspending living donor liver transplant programs during the pandemic, except for pediatric patients with acute liver failure.
All centres are open with DBD nearing normal numbers and DCD increasing.
All living-donor kidney transplantations and deceased donor transplantations in patients that are stable on dialysis are put on hold until the end of the COVID-19 epidemic.
One pancreas centre is open, with all others planning to reopen. 14/23 adult renal transplant centres are open with others planning to reopen.
Consider transplantation from COVID-19 + donors on case by case basis, continue donation as usual if COVID-19 negative. COVID-19 screening results of donor must be available prior to organ recovery.
All deceased donor transplantation in patients that are stable on dialysis are put on hold until the end of the COVID-19 epidemic. Centres can perform kidney transplantation in patients with Eurotransplant high urgency HU) status. Renal transplantation in highly immunized patients with long waiting times can be envisioned in case a well-matched donor kidney against which the patient has no preformed donor-specific antibodies becomes available and the transplant centre considers that the risk-benefit ratio is beneficial and that the necessary resources for successful transplantation are available. Pediatric renal transplantation can therefore be performed in case treating physicians consider the benefit outweighs the potential risks related to COVID-19 infection under high dose immunosuppression. The decision should be taken after discussion with the patient’s caregivers and eventually the patient her- or himself. Kidney-pancreas transplantation is to be suspended except for high urgency transplants or in highly immunized patients according the definition given above for renal transplantation.
Islet transplantation is suspended.
All transplant programs should consider suspending deceased kidney transplants, except for highly sensitized recipients (PRA>=99%) or because of an urgent medical need due to a lack of access to dialysis.
Should report all post-transplant patients with suspected or confirmed COVID-19 to local infection control. Contact ODO and/or UNOS if suspected transmission through donated organ.
Separated systems will keep the infected from the uninfected.
Cohort patients with COVID from non-infected inpatients.
Prudent to limit visitors.
Severe limitations recommended such as only for hospice patients or at time of discharge instructions.
RIVM advises the vulnerable group to stay at home, to receive as little visitors as possible, to keep 1.5 meters away, to wash hands often and to allow contact with others to take place by telephone as much as possible.
Limit all non-essential contact and recommend increased use of distance consultation. Ensure at least 90 day supply of medications.
Recommend distance consultation as much as possible. Limit lab or radiology that requires transfers within or between hospitals. Patients should be given 90 day medication supplies.
Recommend against coming to hospital if symptomatic unless advised by transplant team, encourage phone or video conference visits.
Transplant patients with fever and/or respiratory symptoms should be instructed to call the transplant centre and avoid presenting to the clinic without notifying the centre in advance to avoid inadvertent exposures.
Mention possible increased risk to shed and transmit virus among immunocompromised patients that have COVID-19.
Transplant units advised to consider ways to limit hospital attendance for patients such as (rescheduling on urgent out patient appts, virtual or tele-medicine or telephonic appts, home delivery of immmunosuppression if feasible). Patients with stable graft function and adequate drug supply can avoid routine follow-up visits to transplant hospitals.
Determine approaches to minimize exposure to the healthcare setting.
Contact transplant program if develop fever and/or respiratory symptoms, GI symptoms and other COVID related symptoms.
Recommend all symptomatic patients contact transplant teams and avoid general hospital areas.
When should I contact my medical specialist in the hospital?
• If you have a fever above 38 degrees
• If you feel feverish and have a cold like coughing, sore throat or cough
Increased risk of infection and severity among immunocompromised likely though unproven.
Fever, cough, difficulty breathing; immediately call respective transplant centre.
Implement procedures to screen patients coming to clinic for fever and respiratory symptoms.
CDC is recommending masks when in public for everyone.
Current risk is unknown but that severe disease have been reported.
One should assume that it is likely to acquire COVID-19 disease from a blood entry pathway.
State that evidence from SARS and MERS does not suggest increased mortality for post-transplant patients. Immunosuppression may decrease severity of disease but likely increases viral shedding.
Transplants are probably just as likely to get the COVID-19 virus as people without a transplant. It is much more important to properly follow the guidelines of the RIVM. This will reduce your chance of getting a Corona virus infection.
We recommend strict application of protective measures in transplant patients and in case of even mild clinical signs suggestive of COVID-19, a lower threshold for screening since they represent a higher risk population for infection and contagion.
Strict adherence to social distancing and hand hygiene.
Recommend strict adherence to social distancing recommendations.
Limit travel and respect social distancing recommendations (including advocating for patients to work from home).
Follow the advice of RIVM. RIVM advises the vulnerable group to stay at home, to receive as little visitors as possible, to keep 1.5 meters away, to wash hands often and to allow contact with others to take place by telephone as much as possible.
Strictly follow travel advisories and take extra precautions.
Adhere to travel advisories issued by their respective health authorities/govt bodies. This may necessitate postponing travel to countries with >10 infected patients. Recipients should avoid travel to all locations where COVID is currently circulating. Transplant recipients should avoid all cruise ship travel.
Take respiratory precautions and wash hands frequently and thoroughly.
CDC is recommending masks or face covering when in public.
Mask any patient with suspected COVID-19.
Patients with suspected COVID-19 or who require testing to rule out COVID-19 should wear a surgical mask, be placed in isolation and have evaluation and testing coordinated with infection control or Transplant ID team, consistent with local policies.
We recommend strict application of protective measures in transplant patients.
Any symptomatic transplant recipient should wear mask during any hospital or clinic visit, be placed in isolation, and have ID consult for management consistent with local policies.
Recommend adherence to CDC guidelines of avoidance of non-essential travel, including by caregivers or close contacts. Ensure adequate supply of medications if travel necessary. Community spread should be assumed in Canada and US.
Follow national recommendations.
Teams should follow local health department guidelines for isolating, quarantining, testing, and monitoring returned travellers from endemic areas.
14 days after international travel
We recommend against the use of lopinavir/ritonavir for first line therapy given early data that it lacks efficacy and the potential for severe drug-drug interactions.
Consider remdesivir for the treatment of hospitalized patients with severe COVID-19 under the FDA’s EUA; recommends against lopinavir-ritonavir…Hydroxychloroquine with or without azithromycin is not routinely recommended.
The use should be considered in conjunction with local practice or as part of clinical trial.
Specifically told not to change therapy unless advised by physician.
Consider reducing high dose steroids (careful to avoid aderenal insufficiency). Consider reducing calcineurin inhibitor dosage and azathioprine or mycophenolate dosages in the setting of lymphopenia.
Stop antiproliferative agents (MMF/azathioprine), review total burden of immunosuppression, high does steroid can be counterproductive, minimise calcineurin inhibitors in early disease.
Consider holding mycophenolate mofetil or azathioprine while admitted with moderate/ severe illness (with close monitoring for rejection).
Drug-drug interactions with immunosuppressant medications need to be evaluated and managed.
There is overall agreement of stopping antimetabolite drugs and decrease calcineurin inhibitors by 50%. Steroid should be continued on same doses (based on Mass General recommendations).
Decreasing immunosuppression should be considered for infected recipients, if no recent rejection episodes.
Not for asymptomatic patients.
It is very important that patients do not stop taking immunosuppressive medicines.
There is a paucity of data, however, for safety we recommend limited use of induction therapy during this COVID-19 surge. Lymphocyte depletion should be used with great caution.
Current experience does not suggest a change in induction protocols with ongoing use of lymphocyte depleting agents if indicated, but it should be noted that COVID-19 is frequently associated with lymphopenia.
Also to the Vigilance and Surveillance Expert Advisory Committee (VSEAC) of the Organ and Tissue Authority (OTA) in addition to any immediate state and territory reporting requirements.
Test as soon as patient arrives at hospital, especially if they show symptoms.
Lung transplant specifically for COVID-19 related lung disease should be considered with grave caution in carefully selected cases following two negative PCR based tests as noted above. Recent data indicate that myocarditis may occur at this stage, and thorough cardiac evaluation is warranted.
Await full symptom resolution and then have at least 2 negative screens (PCR).
Recipients with active COVID-19 or recovering from an acute COVID-19 infection should not undergo transplantation.
We recommend waiting at least 14 days after initial diagnosis AND two successive negative PCR-based tests at least 48 hours apart PRIOR to transplantation if possible.
Recommend waiting 14 days if candidate travelled through endemic area. Clinical prudence paramount.
WRT to general COVID diagnosis, not recommended. Should only be used to diagnose pneumonia in certain populations.
CT thorax to screen for typical COVID-associated lung lesions is also recommended at admission to the hospital for transplantation.
Does not specify if recommendations are only for DD recipients.
Screen all potential recipients for symptoms prior to calling in from home. Test all patients (depending on availability) with preference for bronchial secretions > nasopharygeal swab > oropharyngeal swab.
Symptom screening and chest assessment. Recipients with active COVID-19 or recovering from an acute COVID-19 infection should not undergo transplantation; NHS advice is for NP and OP swabs for all those admitted to hospital.
Screen all patients as close as possible to transplant surgery, especially if clinical or epidemiological risk factors.
A patient receiving a transplant is tested for COVID19. If the patient is infected with the coronavirus himself, transplantation cannot proceed.
All patients who have returned from countries with >10 infected patients or have been exposed to a confirmed or suspected case of COVID-19 within the previous 14 days should avoid elective clinic visits and surgical procedures (including bronchoscopies in lung transplant patients). Plans should be in place to get required laboratory testing of such patients during the 14 days in such way as to avoid potential exposure of other patients.
NP swab in the 24–48 hours prior to surgery and should not proceed if positive.
Test all symptomatic patients and defer transplantation of COVID-19 + patients. Unclear on utility of screening asymptomatic patients.
We assume that general hospital protocols will stress that all clinics screen people for fever (with protocols to assess those for source of fever).
All potential recipients should be screened prior to transplantation.
All potential recipients have to be screened by naso-pharyngeal COVID-19 NAT ahead of the planned donation procedure.
Those that have been exposed to a confirmed case or suspected COVID-19 patient within last 14 days or who have returned from nations with COVID-19 outbreaks should be tested; anyone with fever, cough or difficulty breathing should call their transplant centre who will specify if testing required.
If available, we suggest PCR-based testing for SARS-CoV-2 by nasopharyngeal/ oropharyngeal swab prior to transplant assuming rapid turn-around. Recommend against transplanting into positive patients if no therapy availabl.
NP swab…positive symptom screen should be deferred.
Deceased donors classified as intermediate risk should be tested by NAT or SARS-CoV-2; Deceased donors with active infection, high risk, or test SARS-CoV-2 positive-> AVOID Tx
Await 28 days after resolution of symptoms.
Can be re-assessed if greater than 21 days post recovery.
Deferred at least 14 days after symptom resolution and negative results of repeat testing.
Negative PCR test.
2 negative NP PCR swabs that are 24 hours apart.
The Ontario Ministry of Health criteria for when to discharge someone from isolation outlines scenarios for home isolation, hospital, and healthcare workers.
a. For hospitalized patients, isolate in hospital until two negative tests (single NP swab), obtained at least 24 hours apart.
b. If discharged home within 14 days of symptom onset, follow advice for individuals at home where viral clearance swabs are not required.
c. If discharged to a long-term care home/retirement home, maintain isolation (droplet and contact precautions) until two consecutive negative tests, obtained at least 24 hours apart. If testing for clearance is not feasible, maintain isolation until at least 14 days from symptom onset
Foreign offers are primarily evaluated by the Medical Director in close collaboration with the international partner organizations. Swisstransplant retains the right to suspend certain services until further notice.
Organs form other Eurotransplant member countries are acceptable for transplantation in Belgium in case donors were screened for COVID-19 by NAT on naso-pharyngeal swabs or broncho-alveolar lavage fluids.
All organ offers from programs such as in the United States where testing of donors may not have reliably occurred, should not be considered on a case-by-case basis.
…If results are not available prior to surgery the doctor discusses risks and possibilities with the patient.
Living donation should not be performed on either a donor or recipient who has returned from countries with >10 infected patients or who have been exposed to a patient with confirmed or suspected COVID-19 within 14 days. Donors should not be utilized if they have fever and/or respiratory symptoms unless SARS-CoV-2 is excluded.
Exclude deceased donor if COVID-19 is suspected due to presence of severe bilateral community-acquired pneumonia and no other cause is identified (irrespective of COVID-19 PCR test results.
Exclude patients with unexplained respiratory failure as cause of death, history of fever or acute respiratory infection (ie. shortness of breath, cough, sore throat) with or without fever, severe bilateral community-acquired pneumonia without any other cause.
Organs from deceased donors (classified low risk) who had recovered from COVID-19 and had resolution of symptoms greater than 28 days prior to procurement with repeated negative testing at least 24 hours apart are more likely to be safe to use.
All donors with inconclusive tests or risk factors (clinical or epidemiologic) should be excluded.
Exclude deceased donors if probable case of COVID-19. A person with fever (>38C) or history of fever (eg. Night sweats, chills) OR acute respiratory infection (eg. Cough, shortness of breath, sore throat) AND who is a household contact of a confirmed case of COVID-19, where testing has not yet been conducted.
Active infection or positive test.
Prudence suggests that organs from positive donors not be accepted.
If the PCR test is positive, organs must not be allocated.
Only if not recovered; if recovered, carefully assessed.
Case by case after a min of 21 days following resolution of symptoms.
No, if someone is infected, he can no longer be a donor.
Use of organs from COVID-19 + donors to be considered on case by case basis and depends on organ.
Implied; not explicitly stated.
Exclude deceased donor if confirmed COVID-19 positive.
« Organs from donors with active COVID-19 should not be used. »
Serologic assays for antibody against SARS-CoV-2 is still in the early stage and likely varies with the different testing platforms. There is no recommendation to include these tests in the donor screening process. Recommend storage of blood for future testing for deceased donors with unavailable test.
Testing of blood is being proposed, but it’s utility is also unknown.
Blood and serum stored for future testing when reliable viral or antibody tests are available.
Not recommended to use rapid tests (antigenic or serologic).
Acknowledge that not currently available.