Table 1 Summary of issues and actions to be undertaken to mitigate the risks for the transplant population and staff related to COVID-19
From: Transplantation during the COVID-19 pandemic: nothing noble is accomplished without danger
Issues and actions | Advantage | Disadvantage |
|---|---|---|
Screening and risk exposure for transplant staff | ||
Extensive screening of transplant staff | Healthcare workers safety Breaking the vicious circle of in-hospital virus transmission | Increased costs More staff quarantined |
Travels reduction – regional organs shipping systems | Reduction of contagion to other hospitals from travelling retrieval surgeons | Need to develop a graft exchange system if not in place yet |
Timing and logistics of transplantation | ||
Screening of waitlisted patients | Thorough information regarding patients awaiting transplants | Costs Logistics of testing for patients currently out-of-hospital |
Recipients testing at the time of transplant offer | Lower costs compared to previous action | Delays before transplant start Possible cancellation of recipient’s transplant |
Back-up recipient in hospital | Prompt replacement if first candidate tests positive | More complex logistics Anxiety and potential frustration for most back-up patients Increased logistics costs. |
Use of machine perfusions to fast-track organ retrieval from unstable donors (applicable only to donors with low-risk COVID-19 history) | Extended preservation time Higher organs yield | Increased costs Aborted procedures if COVID-19 tests return positive |
Teleclinics for follow-up of transplant recipients | Avoiding access to hospital out-patient clinics - decreased exposure to infection | Increased risk of missing potentially relevant yet subclinical health problems |
Transplant benefit | ||
Revisiting local policies of access to transplantation based on hospital resources availability • Privileging “utility” (recipients with expected better outcomes) • Privileging “urgency” (recipients with the highest need) | Realistic approach to resource allocation between COVID and non-COVID diseases • Less resource consumption (faster ICU turnaround, less blood transfusions, etc.) • Treating the sickest patients only and utilize resources for those in desperate need of transplantation | Further stretching healthcare resources with risk of system collapse • Missing the sickest patients; increased mortality without treatment • Uncertainty regarding mortality effect at the “bottom” of the transplant waiting list |