26 March 2020: COVID-19 Testing of Donors/OPTN Policy & Guidance

(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.)

OPTN Policy still does not exist excluding COVID Positive donors.  However, in an update sent out by UNOS on March 24th this guidance was provided: “There have not been any confirmed transmissions of coronavirus reported from untested donors. There are no reports of any transplant hospital transplanting known COVID-positive donors. Without further data, the risk of transplanting known COVID-positive donors prior to the development of a reliable treatment is unacceptably high.”

The majority of donors are now being tested with results coming back prior to recovery.  There are more cases of multiple test being completed. It seems this occurs when a patient has been tested by the hospital and is then tested by the OPO.  Discussions with OPO administration on why they would repeat the test indicate they have written policy that states testing by their lab will be done by all donors or the sensitivity of their testing is higher than that of the hospital ordered test.

OPO/Donors

  • There are donor hospitals who can no longer provide PPE for the donor recovery.  OPO’s are telling transplant centers they will be required to bring their own PPE for recovery and will not be able to scrub if they do not have what is required.  This is understandable, but OPO’s need to include this information is Donor Highlights for early consideration by the transplant/recovery team.  Then review these requirements again when communicating acceptance of the organ.
  • In DonorNet, OPO’s can reduce redundant questions and improve consistency in communication by including details in DonorNet:
    • Clear documentation of COVID testing plan, timeframes for results
    • Ensure temps, WBC’s, x-ray and CT images are available
    • COVID screening questions/answers
    • Relevant information regarding hospital exposures

Transplant Centers

  • As noted above for OPO’s, consider the implications of recoveries where no PPE will be provided by the donor hospital.  Plans should be in place to add PPE to recovery cases and ensure this need is communicated to the team when accepting organs.
  • Refusal codes now exist in DonorNet for COVID specific issues. UNOS shared the following guidance on use of these codes in an email yesterday, March 25.
  • Refusal code 840: COVID-19: candidate-related reason
    • Transplant hospitals should use this code when refusing an organ offer due to a candidate-related COVID-19 reason. While not an exhaustive list, some examples of reasons the code may be used are if candidates:
      • Have had potential exposure.
      • Are symptomatic.
      • Are being tested.
      • Have a positive test result.
    • Do not use this code if you will not accept any offers for a candidate at this time due to the pandemic. In that instance, inactivate the candidate using the inactive reason “COVID-19 precaution
  • Refusal code 841: COVID-19 donor-related reason
    • Transplant hospitals should use this code when refusing an organ offer due to a donor-related COVID-19 reason.
    • While not an exhaustive list, some examples of reasons the code may be used include:
      • Donors with high exposure risk.
      • Donors where no testing is available.
      • Donors with positive or indeterminate test results.
      • When a different specimen type (nasal vs. BAL) is preferred.
  • Refusal code 842: COVID-19: OPO or transplant hospital operational issue
    • Transplant hospitals should use this refusal code when refusing an organ offer due to COVID-19-related operational issues at either the OPO or the transplant hospital. 
    • While not an exhaustive list, some examples of reasons the code may be used include:
      • Organ recovery scheduling issues.
      • OR or ICU bed shortages.
      • Personnel shortages or other ancillary service support issues.
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24 March 2020: Updates in Transplant
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