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Published on: August 15, 2022
Donor Lung Evaluation and Lung Transplantation in the COVID-19 Era
Mehmet Furkan Sahin1, Muhammet Ali Beyoglu, Sinan Turkkan
1From the Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey.
Insights
Lung transplant is feasible during the COVID-19 pandemic, with careful donor evaluation and safety protocols. Donor organ availability significantly decreased, posing the main challenge to transplant continuity.
Area of Science:
- Medicine
- Transplant Surgery
- Infectious Diseases
Background:
- The COVID-19 pandemic significantly disrupted solid-organ transplant processes globally.
- Lung transplant centers faced unprecedented challenges in managing donor and recipient care during the pandemic.
Purpose of the Study:
- To evaluate donor presentations and transplant outcomes at a lung transplant center during the COVID-19 pandemic.
- To describe safety measures implemented throughout the transplant process.
Main Methods:
- Retrospective analysis of 15 lung donor presentations and 5 lung transplant cases between March 2020 and November 2020.
- Rigorous COVID-19 screening for all donors and recipients, including PCR testing and radiological evaluation.
- Transplant procedures and post-operative care were conducted with minimal personnel and strict personal protective equipment (PPE) usage.
Main Results:
- A substantial decrease in donor organ presentations was observed (15 during the pandemic vs. 78 in the prior year).
- All 5 lung transplant recipients tested negative for SARS-CoV-2 post-transplant, with no COVID-19 related complications.
- No significant differences were found between accepted and rejected donors regarding key physiological parameters.
Conclusions:
- Lung transplantation can be successfully performed during the COVID-19 pandemic, even with elevated infection risks.
- The primary barrier to maintaining lung transplant services was the reduced availability of suitable donor organs.
Objectives:
The COVID-19 pandemic, which emerged in late 2019, adversely affected all solid-organ transplant processes. Here we share the donor presentations evaluated in a lung transplant center during the COVID-19 pandemic,the measures taken at every stage of transplant management, and the outcomes of our transplants.
Materials And Methods:
Data from 15 lung donors selected by the national coordination center presented to our lung transplant center as of March 11, 2020, when the first COVID-19 case was reported in Turkey, and data of 5 lung transplant cases in this period were retrospectively analyzed. All donors were examined in detail for COVID-19 disease. Procurement processes for accepted donors,transplant surgeries of recipients, and postoperative follow-up and care processes of recipients were carried out with the least number of personnel, but all with appropriate personal protective equipment.
Results:
There were 15 donor organs procured by our center during a 9-month period coincident with the COVID-19 pandemic. The number of donor presentations to our center between the same dates in the previous year was 78. Five of the 15 donors were accepted, and of those accepted, 4 were male and 1 was female. There was no statistically significant difference between the accepted and rejected donors in terms of the ratio of Pao2 to fraction of inspired oxygen, age, duration of endotracheal intubation (days), and smoking (pack-years). All SARS-CoV-2 reverse transcription-polymerase chain reaction tests performed on bronchoalveolar lavage samples and nasopharyngeal, conjunctival, and rectal samples collected from the recipients during the follow-up period were negative. No pathological finding suggestive of COVID-19 infection was noted in the radiological evaluations.
Conclusions:
Lung transplant can be successfully managed during the COVID-19 pandemic period, despite the high risk of infection.The major obstacle to the continuity of lung transplantin this period was the limited number of donors.
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