Dilemma of organ donation in transplantation and the COVID-19 pandemic

Lung transplantation during the COVID-19 pandemic: Safely navigating the new “normal”

“…This discrepancy may be understood in the context of recent data suggesting that many LTx programs are operating with restrictions, and may have inactivated the majority of patients on the waitlist 29 . Despite speculation that decreased travel due to social distancing and isolation may reduce donor availability, 18 our findings suggest that continued growth of the potential donor pool may reflect an increasing proportion of deaths attributed to drug intoxication and fewer deaths attributed to blunt injury, gunshot wounds, and intracranial hemorrhage, that have previously been more prevalent 30 . The increase in LTx activity at our institution may not be surprising in the context of these data, which suggest that donor lungs are available in sufficient capacity to support ongoing transplantation at a high level for programs with adequate resources and an acceptable risk‐benefit ratio to maintain LTx activity.…”

“…While understanding of COVID‐19 in LTx recipients is limited, 14–16 prior work indicates that waitlist mortality increases significantly when centers eschew acceptable donor offers 17 . Thus, as we continue to elucidate the implications of COVID‐19 in LTx recipients, the community requires new evidence to guide safe and effective LTx during this period 18 …”

COVID-19 Clinical Trials

“…Two confirmed cases suggest similar presentations to non-transplant recipients and both patients demonstrated clinical improvement. A questionnaire of 87 heart transplant recipients in China, of which importantly 96.6% undertook quarantine procedures, did not suggest a markedly elevated rate of SARS-CoV-2 infection in this population(11,12). In a retrospective medical review of 1,524 patients with cancer who were admitted to the Department of Radiation and Medical Oncology in Zhongnan Hospital of Wuhan University from December 30, 2019 to February 17, 2020, the infection rate of SARS-CoV-2 in patients with cancer was 0.79% (95% CI 0.3-1.2%)…”

“…The recognition that many COVID-19 patients have underlying medical conditions that are treated with angiotensin converting enzyme (ACE) inhibitors and AT1 receptor antagonists (28), coupled with the knowledge that hypertension and diabetes treated with these agents have 12 increased ACE2 levels (24), has given rise to the concern that pharmacologic upregulation of ACE2 by RAS inhibitors may influence the infectivity of SARS-CoV-2 in patient population that is already at high risk for severe COVID-19 infection (29). However, as noted in a recent review on this topic, the experimental and clinical data often yield conflicting results with respect the role of ACE inhibitors and AT1 receptor antagonists on ACE2 levels in different pathophysiological contexts (30), suggesting the effects on RAS inhibitors on ACE2 are complex and nuanced, and should not be assumed to be the same for all RAS inhibitors, nor should it be assumed that changes in ACE2 levels in the heart or other tissues necessarily reflect changes in ACE2 levels in the lung, which is the portal of entry for SARS-CoV-2.…”

Donación y trasplante de órganos en medio de la pandemia COVID-19: Consecuencias y retos para un país emergente

“…La organización nacional de trasplantes de España recomienda contar idealmente con prueba microbiológica reciente (RT-PCR < 24 horas) negativa para COVID-19 en el donante cadavérico para proceder con el proceso de donación, también recomienda no descartar donantes con historia de infección por COVID-19 curada y tratada, con doble prueba confirmatoria (RT PCR) negativa y con un periodo mínimo de 21 días tras haber superado el cuadro clínico y haber culminado el tratamiento. 33 Algunos autores plantean que contar con una sola prueba diagnóstica negativa para COVID-19 en el donante cadavérico no constituye un hecho que permita omitir los protocolos para mitigación de riesgo para el personal asistencial, los receptores de trasplante o sus familiares, dadas las limitaciones y variabilidad de la sensibilidad que han demostrado las pruebas diagnósticas 34,35 . En Singapur, por ejemplo, actualmente solicitan tres muestras confirmatorias negativas del tracto respiratorio (RT-PCR) del potencial donante cadavérico para dar inicio al proceso de donación.…”