Ce qui suit est un bref résumé des lignes directrices compilées à partir des recommandations en don et transplantation accessibles publiquement et compilées en partenariat avec la Société Canadienne du Sang (SCS), la Société Canadienne de Transplantation (SCT) et le Programme de Recherche en Don et Transplantation du Canada (PRDTC). Les recommandations varient de sociétés internationales telles que The Transplantation Society à des organismes nationaux. Les informations seront mises à jour régulièrement à mesure que de nouvelles recommandations ou des révisions seront disponibles.

Il ne s’agit pas d’un échantillon complet de tous les groupes qui ont formulé des recommandations liées à la COVID-19. Les premiers documents analysés comprennent l’information qui a été rassemblée sur le site Web de la Transplantation Society au moment de l’exercice. D’autres révisions de ces résumés incluront des documents et des recommandations d’autres groupes à mesure qu’ils seront disponibles et basés sur les commentaires de la communauté en don et transplantation.

Les déclarations résumées ci-dessous sont des opinions d’experts et/ou des déclarations/recommandations consensuelles publiées par divers individus ou sociétés, à l’échelle internationale. Les déclarations préliminaires relatives à la transplantation dans le cadre de la COVID-19 ont été systématiquement recherchées. Les déclarations résumées ne sont pas nécessairement basées sur des preuves empiriques, ni sur les valeurs et les préférences du patient. Veuillez noter qu’aucune de ces recommandations n’est destinée à servir de recommandations officielles aux professionnels de la santé et aux décideurs endossés par le Programme de Recherche en Don et Transplantation du Canada.

Bien que nous reconnaissions la distinction entre le pathogène viral SRAS-COV-2 et la COVID-19, la maladie causée par le virus, dans un souci de simplicité et de lisibilité, nous nous référerons principalement à la COVID-19. Par exemple, lors du dépistage de donneurs potentiels, nous indiquerons que nous effectuons un dépistage de la COVID-19, sachant que les tests sont conçus pour détecter la présence du SRAS-COV-2.

Terminologie abrégée utilisée : Y (Yes, pour indiquer des recommandations) / N (No, pour indiquer non-recommandé) / NR (Aucune recommandation, pour indiquer qu’aucune recommandation n’a été proposée par l’établissement). Cliquez sur les lettres soulignées pour afficher les recommandations.

Un merci spécial à : Matthew Weiss, Allison Mah, 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, Hyunyun Kim.

À noter que les documents sont en anglais.

Dernière mise à jour : 24 avril 2020

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. It was universally implied or explicitly stated that the screening of donors should include questions for clinical symptoms and exposure risk. How to interpret these screening questions varied, with substantial variability regarding the definition of intermediate or high risk based on screening questions. Some groups also stated that negative laboratory findings do not preclude the need to perform detailed questioning for all patients to evaluate potential risk. Regarding laboratory testing, nearly all groups recommended routine laboratory screening of all patients who were potential donors. The exception was primarily from organisations that published recommendations early in the outbreak and distinguished between areas with high versus low rates of transmission. For those organizations they mention that it may be possible to only test patients who are determined to be high risk based on questions related to symptom history or exposure risk, particularly if access to laboratory testing is limited.

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 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 NNRhttps://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
AsiaIndian Society of TransplantationYNRhttps://content.tts.org/content/covid19/ISOT_COVID_V1_March_26.pdf
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 NYhttps://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/
SwisstransplantYNREnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
North AmericaAmerican Association For The Study Of Liver DiseasesNRYhttps://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 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 YYhttps://www.myast.org/covid-19-information
https://unos.org/covid/

Nasopharyngeal Swab (Polymerase Chain Reaction) PCR Testing (column 1)

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 Swab (Polymerase Chain Reaction) PCR Testing (column 2)

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. Only the joint Canadian recommendations specifically recommended against the use of OP swabs, primarily due to ease in operator technique standardization and improved patient tolerance.

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, with only the Belgian Transplantation Society and the International Society of Heart and Lung Transplantation recommending for their routine use. The justification was the potential to discover radiologic evidence of COVID-19 prior to symptom development in this population. No organization 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 recommend the current use of blood work (antibody or serology testing) for clinical decision making. The ONT in Spain specifically recommended against such a use of blood tests pending a better understanding of their utility. However, several groups including the NHSBT in the United Kingdom and the joint Australia/New Zealand recommendations include advice to store blood or serum for future retrospective testing as it becomes more widely available and understood.

Enhanced testing or procedures for “at risk” potential donors (e.g. travel history or symptoms) (column 4)

Some groups recommended that patients who are identified to be at high risk either through a review of their symptoms or through potential contact risk should have additional testing. This included a requirement of at least two negative tests for high risk patients (Canadian joint recommendations) or requirement for BAL secretion testing (European Society of Transplantation). Blood samples of patients who are considered intermediate or high risk were also recommended by the American United Network for Organ Sharing (UNOS). There was substantial variability both in the follow up testing for these “at risk” populations and who populations were determined to be “at risk”.

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/tid-about/tid-presidents-message/23-tid/tid-news/657-tid-update-and-guidance-on-2019-novel-coronavirus-2019-ncov-for-transplant-id-clinicians
AsiaIndian Society of TransplantationNRNRNRYNRNRhttps://content.tts.org/content/covid19/ISOT_COVID_V1_March_26.pdf
AustralasiaAustralian Government Organ and Tissue Authority and The Transplantation Society of Australia and New ZealandYYNYNRYhttps://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 FoundationNRNRNRNRNRNRhttps://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie
Organización Nacional de Trasplantes YYYYNRNhttps://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf
NHS Blood and TransplantYYYNRNRYhttps://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/
SwisstransplantYYNNRNRNREnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
North AmericaAmerican Association For The Study Of Liver DiseasesNRNRNRNRNRNRhttps://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 TransplantationYNYYNRNRhttps://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 YYNRYNRYhttps://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, the only group that did not categorically exclude patients with documented COVID-19 infection was the Agence Biomédicale in France. In this initial, they recommend that in the case of life saving transplantation – e.g. for a recipient in end stage heart failure and ineligible for a mechanical device – the risks and benefits should be carefully considered between the patient who is a potential recipient and the treating team. They also excluded donation from patients who had “uncontrolled” infection. All other groups either explicitly or implicitly excluded donation from COVID-19 + donors.

Excluding donors with inconclusive COVID-19 screening? (column 2)

Three screened organizations included a comment that patients with inconclusive testing should also be excluded as potential donors in certain circumstances. For instance, UNOS in the United States recommend that if a patient is judged to be “intermediate risk” and testing is not available, that patient should not be considered a donor. Likewise the Organización Nacional de Trasplantes (ONT) in Spain recommend exclusion of patients with indeterminate testing or clinical screening results.

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 NRNRhttps://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
AsiaIndian Society of TransplantationYNRhttps://content.tts.org/content/covid19/ISOT_COVID_V1_March_26.pdf
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 TransplantYNRhttps://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/
SwisstransplantYNREnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
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 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 YYhttps://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 was one of seven groups to states something similar to: “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 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 NRhttps://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
AsiaIndian Society of TransplantationYhttps://content.tts.org/content/covid19/ISOT_COVID_V1_March_26.pdf
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 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 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/
SwisstransplantNREnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
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 Yhttps://www.myast.org/covid-19-information
https://unos.org/covid/

Three of the groups commented on acceptance of organs from other countries. Early in the outbreak, concern was expressed by the Canadian group that only organs from programs that had adequate access to donor screening should be accepted. No group categorically excluded acceptance of international offers, but stated 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 NRhttps://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
AsiaIndian Society of TransplantationNRhttps://content.tts.org/content/covid19/ISOT_COVID_V1_March_26.pdf
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 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/
SwisstransplantYEnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
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 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 NRhttps://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
AsiaIndian Society of TransplantationNRhttps://content.tts.org/content/covid19/ISOT_COVID_V1_March_26.pdf
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 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 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/
SwisstransplantNREnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
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 Yhttps://www.myast.org/covid-19-information
https://unos.org/covid/

Only one organization, the International Liver Transplant Society, specifically recommended avoiding recovery from donors within endemic or high prevalence areas. The other organizations surveyed made no mention of this issue.

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 NRhttps://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
AsiaIndian Society of TransplantationNRhttps://content.tts.org/content/covid19/ISOT_COVID_V1_March_26.pdf
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 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 https://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
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 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 NAT 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 donors with known, recent COVID-19 positive contacts. If donors do have a recent COVID19 positive contact, 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 YNRNRNRNRhttps://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/tid-about/tid-presidents-message/23-tid/tid-news/657-tid-update-and-guidance-on-2019-novel-coronavirus-2019-ncov-for-transplant-id-clinicians
AsiaIndian Society of TransplantationYNRYNRNRhttps://content.tts.org/content/covid19/ISOT_COVID_V1_March_26.pdf
AustralasiaAustralian Government Organ and Tissue Authority and The Transplantation Society of Australia and New ZealandNRNRNRNRNRhttps://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 TransplantYYNRNRNRhttps://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/
SwisstransplantNRNRNRNRNREnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
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 YYNRNRNRhttps://www.myast.org/covid-19-information
https://unos.org/covid/

For transplant candidates who have recently travelled, it is recommended that 14 days elapse from return from travel before considering transplant eligible. If a transplant candidate develops COVID19, societies recommend resolution of symptoms, at least 2 negative viral NAT tests and 14 days elapse before considering transplant eligible. Few societies comment on the possibility of lung transplant in individuals with severe lung disease related to COVID19 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 NRYNRNRhttps://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
AsiaIndian Society of TransplantationNRNRNRNRhttps://content.tts.org/content/covid19/ISOT_COVID_V1_March_26.pdf
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 FoundationNRNRNRNRhttps://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie
Organización Nacional de Trasplantes NRYYNRhttps://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/
SwisstransplantNRNRNRNREnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
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 NRYNRNRhttps://www.myast.org/covid-19-information
https://unos.org/covid/

Post-Transplant Risk

There is limited guidance related to lymphocyte depleting therapy with those societies addressing this question suggesting reducing the use of lymphocyte depleting therapy during the pandemic.  Regarding maintenance immunosuppression, the general recommendation from available guidance is to not reduce maintenance immunosuppression in asymptomatic transplant recipients. In the setting of recipients with COVID19, it is recommended to consider reduction of immunosuppression with most societies suggesting starting with adjustment to the antimetabolite. This decision should be made in conjunction with the transplant team and should not be self-managed by recipients.

Societies do not comment or recommend against prophylactic anti-SARS-CoV-2 therapy at this time. Regarding therapeutic antivirals, the NHS recommends potential use within a clinical trial whereas the AASLD recommends the use of remdesivir. Due to drug-drug interaction considerations, lopinavir-ritonavir is not favored by UNOS in transplant recipients.

RegionInstitutionRecommend avoidance or decrease of lymphocyte depleting regimens immediately post-transplant?Recommend altering chronic immunosuppresion regime?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 NNNYNRNRhttps://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/tid-about/tid-presidents-message/23-tid/tid-news/657-tid-update-and-guidance-on-2019-novel-coronavirus-2019-ncov-for-transplant-id-clinicians
International Society of Nephrologyhttps://www.theisn.org/covid19/recommendations
AsiaIndian Society of TransplantationNRNRYNRNRNRhttps://content.tts.org/content/covid19/ISOT_COVID_V1_March_26.pdf
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 FoundationNRNNRNRNRNRhttps://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 TransplantNRNRNRYNNhttps://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/
SwisstransplantNRNRNRNRNRNREnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
North AmericaAmerican Association For The Study Of Liver DiseasesNRNNRYNRYhttps://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf
American Society of Transplant SurgeonsYNRNRNRNRNRhttps://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl
Canadian Blood Services and Canadian Society of TransplantationNNRNRNRNRNRhttps://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 NRYNNRNRYhttps://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 COVID19.

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 NRNRNRNRNRNRhttps://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/tid-about/tid-presidents-message/23-tid/tid-news/657-tid-update-and-guidance-on-2019-novel-coronavirus-2019-ncov-for-transplant-id-clinicians
International Society of NephrologyN/AN/AN/AN/AN/AN/Ahttps://www.theisn.org/covid19/recommendations
AsiaIndian Society of TransplantationYYYNRNRNRhttps://content.tts.org/content/covid19/ISOT_COVID_V1_March_26.pdf
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 TransplantYNRNRNRNRNRhttps://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/
SwisstransplantNRNRNRNRNRNREnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
North AmericaAmerican Association For The Study Of Liver DiseasesNRNRYYYNRhttps://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf
American Society of Transplant SurgeonsNRNRYYYYhttps://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 NRYNRNRNRNRTTS.ORG website - pdf Information for transplant programs
United Network for Organ Sharing/American Society for Transplantation YYYYNRYhttps://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 suspect 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 SocietyYYNRNRNRhttps://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
International Society of NephrologyN/AN/AN/AN/AN/Ahttps://www.theisn.org/covid19/recommendations
AsiaIndian Society of TransplantationYYNRNRNRhttps://content.tts.org/content/covid19/ISOT_COVID_V1_March_26.pdf
AustralasiaAustralian Government Organ and Tissue Authority and The Transplantation Society of Australia and New ZealandNRNRNRNRNRhttps://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 FoundationYNRYNRNRhttps://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/
SwisstransplantNRNRNRNRNREnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
North AmericaAmerican Association For The Study Of Liver DiseasesNRYYYNRhttps://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf
American Society of Transplant SurgeonsYYYYNRhttps://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 NRNRNRNRYTTS.ORG website - pdf Information for transplant programs
United Network for Organ Sharing/American Society for Transplantation YYNRNRNRhttps://www.myast.org/covid-19-information
https://unos.org/covid/

Deceased Donation Recommendations

When considering the risks between either transplantation and immunosuppression during a pandemic versus prolonged wait-times prior to transplantation caused by temporary suspension of programs, groups distinguished between lifesaving and non-lifesaving forms of transplantation. The general theme was that if patients on the wait-list could be supported through the time of the pandemic – by prolonging dialysis for instance – then the program would be suspended, but more urgent transplantation – end-stage cardiac or hepatic failure for instance – should be considered on a case by case basis.

There was international variability as to whether deceased kidney and pancreas programs should be suspended entirely or continue with modified operations. Some countries including Canada and the Netherlands recommended complete shutdowns, while others such as Spain and the United Kingdom recommended decreased operations to be assessed on a case by case basis. Some international groups such as The Transplantation Society (TTS), recommended consideration of suspension of deceased donation in countries with widespread community transmission. Multiple factors led to the suspension or decreased level of activities including risk of recipient acquisition post-transplant, unknown risk of donor to recipient transmission (though currently not reported), and limited ICU resources to maintain patients who are potential donors or treat post-operative complications in recipients. Most recommended continuous evaluation of the state of these factors in order to reactivate systems to full capacity as quickly as possible to avoid unnecessary harm to patients awaiting transplantation.

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/tid-about/tid-presidents-message/23-tid/tid-news/657-tid-update-and-guidance-on-2019-novel-coronavirus-2019-ncov-for-transplant-id-clinicians
AsiaIndian Society of TransplantationNRhttps://content.tts.org/content/covid19/ISOT_COVID_V1_March_26.pdf
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 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 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
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 SurgeonsNhttps://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 modification of deceased donation liver transplant programs no group recommended outright suspension of all activity. Thus, groups encouraged programs to be increasingly selective for both donors and recipients, lifesaving donation was recommended to continue on a case by case basis.

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/tid-about/tid-presidents-message/23-tid/tid-news/657-tid-update-and-guidance-on-2019-novel-coronavirus-2019-ncov-for-transplant-id-clinicians
AsiaIndian Society of TransplantationNRNRhttps://content.tts.org/content/covid19/ISOT_COVID_V1_March_26.pdf
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 NRNRhttps://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/
SwisstransplantNRNREnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
North AmericaAmerican Association For The Study Of Liver DiseasesNNRhttps://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf
American Society of Transplant SurgeonsNYhttps://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force#.Xqhd2MhKiUl
Canadian Blood Services and Canadian Society of TransplantationNNRhttps://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/

While several groups recommended modification of deceased donation cardiac or pulmonary transplant programs, no group recommended outright suspension of all activity. Thus, groups encouraged programs to be increasingly selective for both donors and recipients, lifesaving donation was recommended to continue on a case by case basis. The International Society of Heart and Lung Transplantation specifically recommended against general suspension of thoracic organ transplant programs due to their lifesaving nature. Several groups pointed out the particularly increased risk of lung recipients if they were to become infected with COVID-19 post-transplant, but also concluded that there may circumstances of terminal respiratory failure that would justify the risk of transplant even in the setting of a pandemic with significant community spread.

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 pulmonary donation and transplantation?Website/Source of Information
InternationalThe International Society of Heart and Lung Transplantation NYNRNRhttps://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/tid-about/tid-presidents-message/23-tid/tid-news/657-tid-update-and-guidance-on-2019-novel-coronavirus-2019-ncov-for-transplant-id-clinicians
AsiaIndian Society of TransplantationNRNRNRNRhttps://content.tts.org/content/covid19/ISOT_COVID_V1_March_26.pdf
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 FoundationNNRYYhttps://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 TransplantNNNNhttps://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/
SwisstransplantNRNRNRNREnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
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 SurgeonsNYNNhttps://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

The majority of international guidance recommend that programs suspend living kidney and liver donation as well as kidney paired donation programs. If these programs or individual transplants continue, it is uniformly recommended that potential living donors take every measure to limit the acquisition of COVID19 including 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. The majority of guidance recommends symptom screening and viral nucleic acid testing (NAT) of living donors. There is limited guidance around management of living donors with a prior history of resolved COVID19 with those societies who do address this recommending at least two negative viral NAT tests prior to donation.

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/tid-about/tid-presidents-message/23-tid/tid-news/657-tid-update-and-guidance-on-2019-novel-coronavirus-2019-ncov-for-transplant-id-clinicians
AsiaIndian Society of TransplantationYYYNRYNRNRNRhttps://content.tts.org/content/covid19/ISOT_COVID_V1_March_26.pdf
AustralasiaAustralian Government Organ and Tissue Authority and The Transplantation Society of Australia and New ZealandNRNRNRNRNRNRNRNRhttps://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 TransplantationYYYNRNRNRNRNRhttps://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 FoundationYNRNRNRNRNRNRNRhttps://www.transplantatiestichting.nl/nieuwsartikel/covid-19-en-donatie
Organización Nacional de Trasplantes NRNRNYYNRNRNRhttps://content.tts.org/content/covid19/COVID-19-Summary-of-Spanish-recommendations-on-organ-donation-and-transplantation20200413.pdf
NHS Blood and TransplantNNRYNRNNRNRYhttps://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/
SwisstransplantNRNRNRNRYNRNRNREnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
North AmericaAmerican Association For The Study Of Liver DiseasesNRYNRNRNRNRNRNRhttps://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf
American Society of Transplant SurgeonsYYNRNRNRNRNRYhttps://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 YYYYYYNRNRhttps://www.myast.org/covid-19-information
https://unos.org/covid/

Organ Donation and Transplant Professionals’ Personal Protective Equipment (PPE) use

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.

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.

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 YNRNRYNRNRhttps://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 YYNRNRYNRhttps://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
AsiaIndian Society of TransplantationYYNRNRYNRhttps://content.tts.org/content/covid19/ISOT_COVID_V1_March_26.pdf
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 FoundationNRNRNRNRNRNRhttps://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/
SwisstransplantNRNRNRNRNRNREnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
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 SurgeonsYYNRYYNRhttps://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 YNRNRNRNRNRTTS.ORG website - pdf Information for transplant programs
United Network for Organ Sharing/American Society for Transplantation YYNRNRNRNRhttps://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. For the few programs that recommended allowing transplantation from donors who were COVID-19 positive or indeterminate, most stated that consent requirements were quite high, including an explanation of the lack of knowledge around the potential risk of transmission or the consequences if transmission occurred.

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, transplanting a patient who had access to effective organ replacement therapy (e.g. dialysis) would not be recommended until more was known about the risk of COVID-19 acquisition post-transplant and the prognosis of immunosuppressed transplant recipients.

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 ressources 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 YNRNRNRhttps://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
AsiaIndian Society of TransplantationYNRNRNRhttps://content.tts.org/content/covid19/ISOT_COVID_V1_March_26.pdf
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 NRYYNRhttps://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/
SwisstransplantNRNRNRNREnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
North AmericaAmerican Association For The Study Of Liver DiseasesNRYYYhttps://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf
American Society of Transplant SurgeonsYYYNRhttps://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 YYNRNRhttps://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, two groups explicitly recommended that ODOs 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. One group also mentioned that availability of adequate personal protective equipment for ODO staff prior to initiation.

Local recovery team and shipping of organs (column 1)

Three organizations 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, two 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 -. Two groups specifically mentioned that patients should be separated from patients with even indeterminate COVID-19 screening.

Decreased need for post-transplant follow-up reporting or data entry (column 6)

The United Network for Organ Sharing (UNOS) in the United States made initial recommendations for decreasing need for post-transplant data entry to their system in light of potential decreased staffing or resources. These recommendations were meant to be temporary and should be adjusted as staffing and resources return to normal levels.

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 NRNRNRNRNRNRNRhttps://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/tid-about/tid-presidents-message/23-tid/tid-news/657-tid-update-and-guidance-on-2019-novel-coronavirus-2019-ncov-for-transplant-id-clinicians
AsiaIndian Society of TransplantationNRNRYNRNRNRNRhttps://content.tts.org/content/covid19/ISOT_COVID_V1_March_26.pdf
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 FoundationNRNRNRNRNRNRNRhttps://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 TransplantNRNRNRNRNRNRNRhttps://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/
SwisstransplantNRNRNRNRNRNRNREnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
North AmericaAmerican Association For The Study Of Liver DiseasesNRNRNRNRYNRNRhttps://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf
American Society of Transplant SurgeonsYNRNRNRNRNRNRhttps://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 NRNRNRNRNRYNRTTS website - pdf Information for transplant programs
United Network for Organ Sharing/American Society for Transplantation NRYNRNRNRNRYhttps://www.myast.org/covid-19-information
https://unos.org/covid/

International guidance documents recognize that transplant candidates on the wait list are potentially at greater risk of complications related to COVID19 given their end stage organ disease status and the requirement to defer transplant if a transplant candidate becomes infected. To this end, several societies recommend that wait list individuals adhere to social distancing including possible alteration to daily life and work arrangements and that clinic visits are limited to reduce the risk of exposure. There is minimal guidance regarding enhanced screening and testing in wait list patients. The AASLD recommends temperature screening at all clinic visits.

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 YYYNNNRhttps://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 NRYYYNRNRhttps://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
AsiaIndian Society of TransplantationYYNRNRNRNRhttps://content.tts.org/content/covid19/ISOT_COVID_V1_March_26.pdf
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 FoundationNRNRNRNRNRNRhttps://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 TransplantYNRNRNRNRNRhttps://www.odt.nhs.uk/deceased-donation/covid-19-advice-for-clinicians/
SwisstransplantNRNRNRNRNRNREnglish fact sheet: https://content.tts.org/content/covid19/Swiss-Transplant-Fact-sheet-concerning%20donors.pdf
North AmericaAmerican Association For The Study Of Liver DiseasesYYYNRYYhttps://www.aasld.org/sites/default/files/2020-05/AASLD-COVID19-ClinicalInsights-May142020-FINAL-v2.pdf
American Society of Transplant SurgeonsYYYYYNRhttps://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 website - pdf Information for transplant programs
United Network for Organ Sharing/American Society for Transplantation YYYNRNRNRhttps://www.myast.org/covid-19-information
https://unos.org/covid/