Background/Context In March 2020 New York City became the epicenter of the COVID-19 pandemic. By mid-March, nearly all the 6500 employees of the New York City Department of Health and Mental Hygiene (NYC Health Department), the largest public health department in the nation, began working from home. Reports quickly emerged of the immense stress on hospital and public health systems, with critical personal protective equipment (PPE) shortages, lack of testing capacity, and strained emergency response. At the same time, NYC Health Department staff were hearing daily updates about a growing number of COVID-19 cases and deaths among New Yorkers. Agency home visiting staff learned that one of their colleagues had died from COVID-19, and two others became ill, with one requiring hospitalization. While in mourning for our colleagues and the city, it became apparent that, once again, Black and Brown people were disproportionately impacted by a health condition; in NYC the age adjusted rate of hospitalization and death among Black/African-American and Hispanic/Latinx people was twice as high as among White and Asian/Pacific Islander people.(NYC Health 2020a) Meanwhile the NYC Health Department continued to do its work serving pregnant and

Background. The early effects of coronavirus disease 2019 (COVID-19) on transplantation are dramatic: >75% of kidney and liver programs are either suspended or operating under major restrictions. To resume transplantation, it is important to understand the prevalence of COVID-19 among transplant recipients, donors, and healthcare workers (HCWs) and its associated mortality. Methods. To investigate this, we studied severe acute respiratory syndrome coronavirus 2 diagnostic test results among patients with end-stage renal disease or kidney transplants from the Johns Hopkins Health System (n = 235), and screening test results from deceased donors from the Southwest Transplant Alliance Organ Procurement Organization (n = 27), and donors, candidates, and HCWs from the National Kidney Registry and Viracor-Eurofins (n = 253) between February 23 and April 15, 2020. Results. We found low rates of COVID-19 among donors and HCWs (0%–1%) who were screened, higher rates of diagnostic tests among patients with end-stage renal disease or kidney transplant (17%–20%), and considerable mortality (7%–13%) among those who tested positive. Conclusions. These findings suggest the threat of COVID-19 for the transplant population is significant and ongoing data collection and reporting is critical to inform transplant practices during and after the pandemic.

Long periods of significant hypoxia do not disqualify a patient from becoming an organ donor. As the management of organ donor patients becomes more complex, recovery coordinators often have to change their thinking and resort to nonconventional means of management. This case study presents a hypoxic donor and how using pressure-control inverse ratio ventilation improved oxygenation in this donor. Before changing ventilator modes, the transplant surgeons were concerned about the long periods of hypoxia the patient had experienced during her hospitalization. After making the change, improving oxygenation, and demonstrating an improved oxygen state, 4 organs were recovered and subsequently transplanted. All the recovered organs functioned immediately after transplantation without any signs of poor performance. Although this treatment modality is not available at every institution, it can be used to improve oxygenation problems in organ donors.

Long periods of significant hypoxia do not disqualify a patient from becoming an organ donor. As the management of organ donor patients becomes more complex, recovery coordinators often have to change their thinking and resort to nonconventional means of management. This case study presents a hypoxic donor and how using pressure-control inverse ratio ventilation improved oxygenation in this donor. Before changing ventilator modes, the transplant surgeons were concerned about the long periods of hypoxia the patient had experienced during her hospitalization. After making the change, improving oxygenation, and demonstrating an improved oxygen state, 4 organs were recovered and subsequently transplanted. All the recovered organs functioned immediately after transplantation without any signs of poor performance. Although this treatment modality is not available at every institution, it can be used to improve oxygenation problems in organ donors.