There are no best practices in a pandemic: Organ donation within the COVID-19 epicenter

Abstract

LiveOnNY, the organ procurement organization (OPO) for the greater New York metropolitan area, suspended several best practices to manage the rising referrals of deaths from hospitals during the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pandemic. On April 2, 2020 hospitals in the donor service area were notified that coronavirus disease 2019 (COVID‐19) referrals should be deferred. Still, only 2% of referred patients to the OPO in April 2020 were on ventilators and considered possible organ donors, versus a baseline of 11% in 2019. Few of these deaths were unrelated to COVID‐19. Accordingly, organ donors declined to 10 in April (from 26 in March). Despite the exclusion of marginal donors and organs, the implementation of COVID‐19 donor testing, and the availability of local procurement surgeons, only 1 organ (a liver) was accepted by a transplant center outside of New York State and 8 organs (5 livers, 4 kidneys) were transplanted in state; 11 organs (1 liver, 10 kidneys) were discarded. Allocation was unsuccessful for 11 additional organs (1 liver, 4 kidneys, 4 hearts, 2 lungs). Despite the obstacles, organ donation remained an important model of collaboration and satisfaction for the health care community in the pandemic's US epicenter. Declining COVID‐19 deaths led to the resumption of the comprehensive referral policy on May 6, 2020, with improvement to 18 donors in May.

Results of a data-driven performance improvement initiative in organ donation

“…While the pandemic may impact CALC deaths, such changes would be temporary in nature, and affected localities and periods would be easily traceable by means of death data from the same source. Notably, other metrics are also rendered less reliable by pandemic conditions, but in a less predictable fashion, as the technical methods describing eligible deaths do not exclude pneumonia from the denominator and a census of ventilated deaths would be expected to produce many donation‐unsuitable decedents 23,30 . A final limitation of our work is that some of the gains in donation may not be attributable to the actions of the QI itself.…”

Organ recovery from deceased donors with prior COVID‐19: A case series

“…By late April, these rates slowly began to increase as centers and OPOs began to navigate resource availability and risk‐benefit analysis. Operational changes for OPO’s included limited onsite presence at partner hospitals, telephone approaches for authorization, and increases in local recovery and centralized recovery centers 2 . Authorization rates declined as did overall donation and transplantation rates 5,10 …”

“…The recognition and subsequent declaration of the COVID‐19 as a pandemic has dramatically impacted the landscape of organ donation and transplantation in the United States. Some of the earliest publications on the topic highlighted the importance of developing protocols and screening modalities for potential organ donors, based on lessons from prior pandemics, and recommended against recovering organs from a donor with suspected or confirmed COVID‐19, citing risks not only to recipients but also health care and procuring teams 1,2 . Screening of potential organ donors in the United States began in March utilizing both clinical and epidemiologic factors, as laboratories worked to develop specific nucleic acid (NAT) testing.…”

Special considerations in the assessment of catastrophic brain injury and determination of brain death in patients with SARS-CoV-2

“…In March 2020, multiple national and international organizations issued recommendations against the use of organs from donors with SARS-CoV-2 based on the assumption that viral particles could be inadvertently transplanted from a positive donor and result in severe manifestations in immunosuppressed recipients [ 30 ]. Referral for organ donation of patients with COVID-19 to our organ procurement organization (OPO) was temporarily suspended between March 31st and May 6th, 2020 due to compelling, data-driven, requests from front line workers to be released from the obligation to refer COVID-19 patients, the high volume of deaths in hospitals across New York City, the critical shortage of ventilators and a physically and emotionally overwhelmed OPO staff [ 31 ]. Although routine referral of all patients, including those with COVID-19 positive tests, has resumed, there is still limited evidence to support or reject the use of organs from SARS-CoV-2 infected donors [ 30 ].…”