Organ transplantation during the COVID-19 pandemic: Making the best patient care decision

Abstract

It is with great interest and sadness that we read the experience of Akalin et al and Pereira et al 1,2 with unprecedented mortality (18%-28%) in transplant recipients in New York City. High mortality reports in transplant patients have created anxiety among some community practitioners as evidence for why transplants should not be performed at this time, 3,4 contrary to the recommendations from multiple transplant organizations.

Gastrointestinal Bleeding in COVID-19 Patients

“…GIB is clinically apparent, as visible blood loss may manifest as hematemesis, melena, or hematochezia. GIB reflects one of the most common and important medical emergencies, with a mortality rate of 2%–10% ( Mujtaba et al, 2020 ; Schmiderer et al, 2020 ). Hemorrhage from the GI tract is classified as upper GIB, lower GIB, or small bowel bleeding (“obscure GIB”) ( Mujtaba et al, 2020 ).…”

“…GIB reflects one of the most common and important medical emergencies, with a mortality rate of 2%–10% ( Mujtaba et al, 2020 ; Schmiderer et al, 2020 ). Hemorrhage from the GI tract is classified as upper GIB, lower GIB, or small bowel bleeding (“obscure GIB”) ( Mujtaba et al, 2020 ). Overt upper GIB usually presents as melena or hematemesis, or also as hematochezia.…”

The Impact of COVID-19 Pandemic on Living Donor Liver Transplantation: An Integrated Mitigation Strategy with Successful Outcome

“…The impact of the COVID-19 pandemic on transplantation has yet to be fully elucidated. The currently available published data are limited to clinical surveys and a few case series [2][3][4][5][6][7][8][9][10][11][12][13][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33].…”

“…The adopted strategy consisted of three integrated tiers: government rules, ministry of health measures, and AFSHtransplant center protocols. With the timeline depicted in figure 1, most of the universal measures including wearing a mask, social distancing, and hand sanitization were adopted as recommended by the World Health Organization and Centers for Disease Control [1][2][3][4][5][6][7][8][9][10][11][12]. All international flights, worship facilities, and education institutes were suspended with an enforced countrywide nighttime curfew.…”

“…Most of the world experts advocated temporary halt or reduction of solid organ transplantation with a staged approach gauged by the surge of the infection, resource availability, and risk tolerance [1][2][3][4][5][6][7][8][9]. Meanwhile, mitigation strategies were proposed with a global perspective to successfully navigate the pandemic and ultimately fully restore transplant activities [1][2][3][4][5][6][7][8][9][10][11][12][13].…”