COVID-19 and US Transplant System: March 22; Updates March 23 (10 am, 11pm); March 25

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Here is the link to the March 23 Town Hall.

What follows is the post before this webinar became available that can still serve as useful background and on-the-ground information.

The New CMS guidelines (of March 20, 2020) open with:

Transplant surgeries should be considered high priority and should not be postponed during the COVID-19 pandemic, if possible. 

But different transplant centers and OPOs are operating with different guidelines. 

Tomorrow (Monday March 23, 2020) there is a UNOS/OPO/Transplant Center leadership town hall that may clarify and systemize where we stand.

It was open to 1000 participants, but is now full.

Please look out for any links that are available after that, and please contact your own Transplant Center(s) to see how it affects you (or your loved one).

I asked five of my colleagues from across the country to get a sense of what is going on:

What about transplants and donations? Are these on hold? Or being done on a case by case basis? Or being considered essential, they are proceeding (with appropriate precautions) on a near-normal rate? 

Here are the responses.

From Jim Markmann (MGH):

Mostly the latter for us.
Not doing live donor kidneys right now. 
Livers remain active and deceased donor kidney have some restrictions.
And all donors have to test negative for COVID

From John Roberts (UCSF):

Currently we are continuing to do all types of kidney and liver transplants. Looks like California may avoid some of the tribulations,.. Currently at UCSF, we have 12 positive patients in the hospital and 2 in the ICU. These numbers have been pretty stable for a few days. We have dramatically expanded our testing ability at UCSF; <12 hour TAT, 350 tests per day so the number of overall infections in the county is rising about not many ill patients. My guess is the lockdown has been effective.

Still working and seeing referral…essential personnel. Our HD liaisons are not going into hospitals right now.  Have scaled way back and have an algorithm of who we will and will not go on-site for. AOCs are involved in every person going on-site—to make the decisions with our referral coordinators. Testing all donors for Covid-19. Getting the results before OR. Some transplant programs have shut down. Others are still accepting. As long as they are open, I’m told we will continue to save lives and our company is updating daily on how we are keeping ourselves safe. As you know, it’s a fluid process. Things are changing often!  

Lacey Gwyn (OPO in Georgia)


We are doing well! Thank you for asking. 

We are still working very hard in the field. We’ve had to alter a lot of our field protocols to limit our staff’s exposure to potentially sick patients and reduce stress on hospital units. 

Tomorrow is a big day, as the leadership from all of transplant centers and OPOs will host a town call tomorrow afternoon. If transplant centers decide to press the pause button our entire industry will come to a stop. 

I will keep posted! 

Thank you, 

Michael Clay (OPO in Lousiana)

From Al Roth (Stanford University):

Hi Sridhar: much of the transplant community is responding in a fairly risk averse way.
Living donor kidney transplants are being postponed (as are all sorts of elective surgeries, to free up beds for a possible crush of corona virus patients).
More concerning to me is that some places are rejecting deceased donor organs that don’t have a no-corona certification (and there’s a shortage of test kits).  This includes hearts…:(

al

Please look out for updated guidelines tomorrow or the day after. 

Stay safe. Let us not get consumed by hysteria that prevents rational decision making.

Update: I have been in contact with other colleagues after 5pm.

From Sundaram Hariharan (UPMC):

Deceased donor kidneys are being done at the current time. However, that could change drastically if the number of COVID-19 patients in the city, county or at UPMC increases drastically.

From Parsia Vagefi (UT Southwestern):

Hi Sridhar 
We are continuing deceased donor transplants (6 kidneys Friday into Saturday). We postponed living donor kidney and liver for a couple weeks.
We are using tele health for most visits. 
Paired down inpatient and outpatient teams to bare minimums for now. 
Thanks,
Parsia Vagefi

Update (10am Monday 3/23/2020):

Good Morning!

I hope all is well. Donation is considered an essential surgery and will proceed with COVID-19 testing on donors. It has added some complexities to the process though.

Jenny Miller
Program Manager
Association of Organ Procurement Organizations

Folks may also benefit from the kinds of exchange taking place between transplant surgeons: John Roberts (UCSF) with a response from Heidi Yeh (MGH).

I was recently sent the enclosed essay. I am passing it along because I basically agree with the analysis. Let me know if you decide differently. It is worth reading the WHO report from China. It dispels the concerns about nosocomial infections being passed to healthcare workers once the recognition of the risk and implementation of PPE. Probably also little risk of patients acquiring in hospital. The COVID risks need to be compared to the risks of dying from ESOD by delaying transplants. Obviously, this needs to be tempered by Bed, blood, PPE, staff, etc.   There is going to be a lot of collateral deaths from turning away  patients, particularly those who need a therapeutic procedure, who are at risk from non-COVID illnesses but probably these will never be tabulated.

I agree we should continue transplanting, but it’s difficult to make any conclusions about hospital transmission based on data out of China.  One of our graduate school friends had a 30-some year old friend who was a physician taking care of Coronavirus patients and just died of “overwork” as the official cause of death.  If we’re passing c diff and MRSA from one patient to another, it’s hard to imagine there is *no* passage of Coronavirus, especially when we do less testing for COVID-19 than VRE and hospitals are running low on PPE.

Update (10 am March 25). From Sommer Gentry (USNA) married to Dorry Segev (Johns Hopkins):

…he says the transplant program is slowing down.  They are still taking very close match deceased donor kidneys, and doing urgent liver transplants for patients with higher disease severity.

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