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Child Organ Offer Process (cOOPS): Understanding Infectious Risk Assessment and Mitigation Strategies
Trinity Lee1, Katya Prakash2, Hannah Bahakel1
1Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio, USA.
Insights
Pediatric Infectious Disease clinicians show strong agreement on accepting donor organs with common infections like SARS-CoV-2, but less consensus exists for rarer pathogens. Practice patterns for post-transplant management and donor testing vary, indicating a need for improved education and research in pediatric organ transplantation.
Area of Science:
- Pediatric Infectious Diseases
- Solid Organ Transplantation
- Infection Control
Background:
- Pediatric Infectious Disease (PID) clinicians evaluate infection risks for donor organ offers in solid organ transplantation.
- Current practice patterns for real-life scenarios are not well-described.
Purpose of the Study:
- To describe the practice patterns of PID clinicians regarding donor organ acceptance and post-transplantation interventions.
- To identify areas of consensus and variability in decision-making for pediatric organ offers.
Main Methods:
- A survey was distributed to PID clinicians via 3 PID-specific listservs.
- 12 fictitious pediatric case scenarios were used to assess organ acceptance and post-transplantation interventions.
- Descriptive statistics were employed to analyze the survey data.
Main Results:
- High agreement (>80%) was observed for accepting organs with syphilis, SARS-CoV-2, MRSA, E. coli, TB (liver), and rhino/enterovirus.
- Lower agreement was found for organs with risks of coccidioidomycosis, Chagas disease, multidrug-resistant Acinetobacter baumannii, and influenza.
- Variability existed in post-transplant monitoring, antimicrobial administration, and donor testing for specific infections like SARS-CoV-2, MRSA, and Chagas disease.
Conclusions:
- While consensus exists for many pediatric organ offer scenarios, enhanced education on current recommendations can improve decision-making.
- Variability in management highlights opportunities for education and research to optimize strategies against donor-derived infections in pediatric recipients.
Introduction:
Pediatric Infectious Disease (PID) clinicians involved in solid organ transplantation often assess infection risk and mitigation strategies for donor organ offers. While some guidance is available, real-life practice patterns have not been previously described.
Methods:
We surveyed PID clinicians about organ acceptance and associated posttransplantation interventions using 12 fictitious pediatric case scenarios through 3 PID-specific listservs. Descriptive statistics were employed.
Results:
48 (71.6%) of 67 ID respondents were involved in organ offer assessment. Agreement was strong (> 80%) to accept (syphilis, severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], MRSA, E. coli, TB [liver], rhino/enterovirus) or decline (undifferentiated encephalitis, TB [lung]) organs from these cases, while there was less agreement for cases with risk of coccidioidomycosis, Chagas disease, multi-drug-resistant Acinetobacter baumannii, and influenza. Less agreement was present for posttransplant monitoring and antimicrobial administration. Practice varied in testing and treatment for donors with SARS-CoV-2 positive test, MRSA bacteremia, and Chagas disease.
Conclusions:
For many pediatric organ offer scenarios, agreement in donor acceptance was high; however, improved education based on currently available recommendations may enhance organ acceptance decision-making. The variability in management highlights educational and research opportunities to optimize strategies to limit the impact of donor-derived infections in pediatric organ recipients.
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