Practical Considerations for Solid Organ Transplantation During the COVID-19 Global Outbreak: The Experience from
Shimin Jasmine Chung1,2, Ek Khoon Tan2,3, Terence Kee2,4
1Department of Infectious Diseases, Singapore General Hospital, Singapore.
Insights
Transplant services can continue safely during pandemics like coronavirus disease 2019 (COVID-19) by implementing tiered guidelines. This approach ensures essential organ transplants proceed while prioritizing patient safety and managing risks effectively.
Area of Science:
- Medicine
- Public Health
- Transplant Surgery
Background:
- The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted global healthcare systems.
- Essential medical services, including organ transplantation, face disruption due to resource diversion and patient safety concerns.
Purpose of the Study:
- To present guidelines and experiences for safely managing transplant services during the COVID-19 pandemic.
- To outline strategies for donor and recipient selection and management in a pandemic setting.
- To discuss clinical challenges related to managing coronavirus disease 2019 in post-transplant recipients.
Main Methods:
- Adoption of a tiered approach based on outbreak alert levels.
- Development of hospital guidelines informed by the best available evidence.
- Successful execution of lung and liver transplant procedures during the COVID-19 era.
Main Results:
- Life-saving organ transplants can be safely performed even during a pandemic.
- Established guidelines facilitated the continuation of transplant services.
- Successful lung and liver transplants were completed, demonstrating feasibility.
Conclusions:
- A structured, evidence-based approach enables the safe continuation of vital transplant services during pandemics.
- Careful management of donor and recipient selection is crucial for successful outcomes.
- Addressing clinical dilemmas in post-transplant care is essential for patient well-being.
Abstract:
The current coronavirus disease 2019 (COVID-19) pandemic has not only caused global social disruptions but has also put tremendous strain on healthcare systems worldwide. With all attention and significant effort diverted to containing and managing the COVID-19 outbreak (and understandably so), essential medical services such as transplant services are likely to be affected. Closure of transplant programs in an outbreak caused by a highly transmissible novel pathogen may be inevitable owing to patient safety. Yet program closure is not without harm; patients on the transplant waitlist may die before the program reopens. By adopting a tiered approach based on outbreak disease alert levels, and having hospital guidelines based on the best available evidence, life-saving transplants can still be safely performed. We performed a lung transplant and a liver transplant successfully during the COVID-19 era. We present our guidelines and experience on managing the transplant service as well as the selection and management of donors and recipients. We also discuss clinical dilemmas in the management COVID-19 in the posttransplant recipient.
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