21 March 2020: Trends in Transplant & Considerations in COVID-19 Testing in Donors
(Disclaimer: These insights are provided from compilation of text, phone calls, listserve and social media discussions. They are not a definitive source of data, but are meant to share challenges and ideas so that others can learn from them. Please share with us if you have experiences or publications we can incorporate.)
This week has proven that when necessary, OPO’s and transplant centers can work to be flexible and adapt to change as well as any other organizations. However, communication tools beyond that of a professional organizations listserve remain a disabling factor for information sharing around the country.
COVID-19 Testing of Donors
OPO testing of donors has become more consistent this week, although policy still does not exist mandating testing. There has been frustration from some that the OPTN has not provided policy; however, it seems to be clear now why this has not happened. There are still many issues with consistently obtaining testing in a manner that facilitates organ donation.
- Timeframe for testing
- Although the platforms for donor testing are considered rapid platforms and in theory should result in 8-12 hours, results often are not obtained for 48-72 hours.
- Backlog of test
- Inconclusive results leading to repeat testing
- Transportation challenges as flights become more limited
- INCONCLUSIVE Results from donors- Donor results seem to have a much higher incidence of repeat testing and are coming back with a significant number of “Inconclusive” results. 2 different sources in the OPO’s advised that the donor population tested have a 39-40% rate of “inconclusive” results. Testing with swabs is considered more accurate; however, with the shortage of swabs this is not a feasible option for most OPO’s.
- This creates a SIGNIFICANT issue when recovery and transplant take place prior to receipt of results. Because the donor has passed away at the point of the inconclusive results, a new sample can not be obtained for testing.
- CONSIDERATION: If transplanting prior to COVID-19 testing results, consider obtaining a sputum or swab sample for at least a short-term archive until results are obtained and test need to be repeated.
WHAT OPO’s CAN DO NOW
- From experience we all know that onsite coordinators from the OPO can be overwhelmed with ensuring all information is shared with all parties involved. Consistent documentation in Donor Highlights could reduce some of the many calls and ensure COVID-19 testing and screening information has been placed in front of every center receiving an organ offer. Include in that information answer the following questions at a minimum: Is COVID-19 testing being done? ETA for results? Response to COVID-19 screening questions prior to admission? Since admission, has there been any concerns for exposure? Any symptoms consistent with COVID-19? If an OR time is set prior to results being obtained, why and is there any flexibility in this?
- Consider using the “Increased Risk” documentation forms in OPO software (Transplant Connect, True North, ETC) for ensuring accepting centers are advised of pending test results, exposure risk, symptoms prior to recovery. We realize this is not what this section was built for, but in the long term it will provided OPO’s the documentation necessary in the event of a potential disease transmission.
WHAT TRANSPLANT CENTERS CAN DO NOW
- Transplant Centers were given the ability to make patients Inactive if they are choosing to limit transplants during this pandemic. This protects the potential recipients wait time using a “COVID-19 Precautions” code. To assist donor hospitals and OPO’s moving forward, it would be of great value for transplant centers to use these codes and make patients inactive they are not transplanting as opposed to simply declining the all offers when they come.
- Resources in hospitals are going to become more scarce (beds, ventilators, staff, etc) and supporting donors may become a lower priority. For donors considered “marginal”, being able to generate a Test Donor in UNET and determine if there are recipients awaiting specific organs would allow OPO’s to focus and advocate for the test that are necessary.
- By only having patients who are actively being considered for transplants on match runs, the OPO can move through allocation much quicker. This supports both the OPO and donor hospital with resources while also limiting the OPO’s staff exposure in hospitals where COVID-19 patients are potentially being treated.