Global Transplantation COVID Report March 2020

Abstract

The COVID-19 pandemic has hit the entire world in an almost unprecedented way. The crisis has spread rapidly, disease burden and casualties continue to rise, and the impact of the crisis is spreading through developing countries. Social distancing, travel restrictions, and intensified testing have improved the rate of the rise in new cases in some regions; however, it remains unclear when normality will return. Mechanisms of the disease remain largely unclear; treatment, if available, is mostly supportive. As during times of war, the challenges of the coronavirus crisis change our views in almost any aspect. Transplant patients and those with end-stage organ failure are in a particular vulnerable position. Elective surgeries including live donor transplant procedures have paused in many countries. Deceased donor transplants, where the procedure is established, continue in some countries, albeit with modified donor and recipient criteria, in an attempt to reduce the risk of COVID transmission or an infection after transplantation. Those who are immunocompromised are probably at increased risk of severe disease, though the role of immunosuppression is debated and uncertain. Communication of knowledge is a critical component of the current crisis. Responses, experiences, and outcomes have been different around the world as different countries and regions experience different impacts and different rates of infection and death. Sharing how others have coped in practice will assist in planning and managing this most stressful and challenging situation for patients and health workers alike. As a transplant community, many are currently engaged in optimizing our immediate responses. With our actions largely based on epidemiological assessments, there is a critical lack of data on the consequences of COVID on transplant patients or those with end-stage organ disease. This report is designed to assist in understanding the approaches taken in other countries and different phases of the epidemic. There are new opportunities coming to the forefront in these otherwise gloomy days: virtual meetings, clinical visits, increased use of electronic communication, and improved remote monitoring may very well be one of the beneficial legacies of this crisis and our responses. Editors and contributors to Transplantation have shared their thoughts on how they are dealing with the current crisis. While we understand that the information of today may be quite different tomorrow in this fast-moving pandemic, this report will open our forum of an international exchange on COVID for the transplant community. AUSTRALIA Acute transplantation activity has substantively reduced nationally. Living donor kidney transplantation has stopped for the past few days, and deceased donor transplantation, which was being assessed on a case-by-case basis, has also stopped entirely for a period, depending on hospital Intensive Care and Emergency Department capacity. All deceased donors have required COVID testing, but the number of deceased donors has dropped dramatically. We have also slowed down all elective surgery, endoscopies, and bronchoscopies, as well as auxiliary and allied health services. The government has today banned all nonurgent elective surgery. We are committed to ensure the safety and well-being of our transplant recipients, and as a clinical group, we have decided it would be inappropriate to subject high-risk patients to intensive immunosuppression during the COVID-19 pandemic. Reduced expert staff availability and a limited supply of Personal Protective Equipment availability are additional concerns for frontline clinical staff. Chronic transplant recipients are being distributed to consultants’ private clinics as well as using telehealth and “apps” for consultations. Laboratory tests are being done outside the hospitals in private pathology laboratories. Clinic have been COVID for and Transplant recipients are to use telehealth for their for the and is for patients with and challenges availability and the lack of in patients and their and to a and the and to a telehealth activity and clinical have also been We have stopped all and in when We have stopped donor kidney transplantation and are of deceased donor for recipients they are All deceased donor kidney have been assessed on a case-by-case to for a transplant at this but we have a on We are planning to that in All donors be for COVID-19 transplantation. All recipients have been the transplant travel and and but we have the recipients for COVID-19 in is to reduce and testing as continue current tests with on a case-by-case and reduce We are to ensure that all tests are taken at for patients Transplant will patients at and their clinical and this will be the to the tests to and the kidney transplant in have donor kidney and all new or to reduce the risk of COVID-19 recipient and donor deceased donor kidney and have been on for patients currently on the who have been or those with to is very The transplant has a to The transplant has been to for critical patients with and this is being in patients continue to be on a case-by-case transplantation deceased donors remains with donor after being to donors of Living donor transplantation but patients with increased continue to be in patients at the risk of have been on deceased we have a clinical in with our organ all deceased donors the organ are with for COVID-19 on and All recipients are also being for COVID-19 in of their times are recipient COVID-19 testing are transplantation. 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