24 March 2020: Updates in Transplant
(Disclaimer: These insights are provided from compilation of text, phone calls, listserv 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 any resources you believe useful to the group.)
Things are literally changing by the hour for healthcare providers around the country. Donation & transplant are being impacted by the resource limitations imposed on hospital systems. Communication tools beyond that of a professional organizations listserv remain a disabling factor for real-time information sharing around the country.
COVID-19 Testing of Donors
OPO testing of donors continues to be more consistent, although policy still does not exist mandating testing. We all hope that the testing from Cepheid, approved by the FDA last week, will be available this week and provide more testing options, closer to the donor hospital and with a rapid turnaround.
WHAT OPO’s CAN DO NOW
- Look into alternate transportation arrangements now. Commercial flights are becoming less available and cargo services at major airports are limiting hours which will make it more challenging to transport kidneys commercially.
- Talk with local recovery surgeons and create plans for local recoveries; both planned and for expedited cases as resources dictate quicker recoveries.
- 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? R
- esponse 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?
- Look into alternate transportation arrangements now. Flights are becoming less frequent and cargo services at major airports are limiting hours which will make it more challenging to transport kidneys commercially.
WHAT TRANSPLANT CENTERS CAN DO NOW
- When accepting organs, evaluate recipients early for suitability regardless of the OR time and timeframe for obtaining COVID-19 results. Last minute refusals for recipient issues has already led to viable organs not being transplanted.
- 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 tremendous 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.