Clinical Practice Guideline for Solid Organ Donation and Transplantation During the COVID-19 Pandemic

Matthew J Weiss; Laura Hornby; Farid Foroutan; Sara Belga; Simon Bernier; Mamatha Bhat; C Arianne Buchan; Michael Gagnon; Gillian Hardman; Maria Ibrahim; Cindy Luo; Me-Linh Luong; Rahul Mainra; Alex R Manara; Ruth Sapir-Pichhadze; Sarah Shalhoub; Tina Shaver; Jeffrey M Singh; Sujitha Srinathan; Ian Thomas; Lindsay C Wilson; T Murray Wilson; Alissa Wright; Allison Mah

doi:10.1097/TXD.0000000000001199

Clinical Practice Guideline for Solid Organ Donation and Transplantation During the COVID-19 Pandemic

Transplant Direct. 2021 Sep 7;7(10):e755. doi: 10.1097/TXD.0000000000001199. eCollection 2021 Oct.

Authors

Matthew J Weiss^{1

2

3}, Laura Hornby^{3

4}, Farid Foroutan^{5

6}, Sara Belga⁷, Simon Bernier⁸, Mamatha Bhat^{9

10}, C Arianne Buchan¹¹, Michael Gagnon¹², Gillian Hardman¹³, Maria Ibrahim^{13

14}, Cindy Luo¹⁵, Me-Linh Luong¹⁶, Rahul Mainra^{17

18}, Alex R Manara^{13

19}, Ruth Sapir-Pichhadze^{12

20}, Sarah Shalhoub²¹, Tina Shaver²², Jeffrey M Singh^{23

24}, Sujitha Srinathan⁹, Ian Thomas^{13

19}, Lindsay C Wilson⁴, T Murray Wilson^{25

26

27}, Alissa Wright⁷, Allison Mah⁷

Affiliations

¹ Transplant Québec, Montréal, QC, Canada.
² CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Université Laval, QC, Canada.
³ Canadian Donation and Transplantation Research Program (CDTRP), Ottawa, ON, Canada.
⁴ System Development - Organ and Tissue Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada.
⁵ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
⁶ Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, Toronto, ON, Canada.
⁷ Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
⁸ Faculty of Medicine, Université Laval, QC, Canada.
⁹ Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
¹⁰ Multiorgan Transplant Program, University Health Network, University of Toronto, Toronto, ON, Canada.
¹¹ Division of Infectious Diseases, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
¹² Division of Nephrology and Multi-Organ Transplant Program, Department of Medicine, McGill University, Montreal, QC, Canada.
¹³ National Health Service Blood and Transplant, Bristol, United Kingdom.
¹⁴ Kings College, London, United Kingdom.
¹⁵ Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.
¹⁶ Department of Microbiology, Infectiology and Immunology, Université de Montréal, Montréal, QC, Canada.
¹⁷ Division of Nephrology, University of Saskatchewan, Saskatoon, SK, Canada.
¹⁸ St. Paul's Hospital, Saskatchewan Transplant Program, Saskatoon, SK, Canada.
¹⁹ Department of Intensive Care Medicine, Southmead Hospital, Bristol, United Kingdom.
²⁰ Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, QC, Canada.
²¹ Division of Infectious Diseases, Department of Medicine, Western University, London, ON, Canada.
²² Southern Alberta Organ and Tissue Donation Program, Calgary, AB, Canada.
²³ Department of Medicine, University of Toronto, Toronto, Ontario, ON, Canada.
²⁴ Trillium Gift of Life Network, Toronto, ON, Canada.
²⁵ Transplant Research Foundation of British Columbia, Vancouver, BC, Canada.
²⁶ Patient Partner, Canadian Donation and Transplantation Research Program.
²⁷ The Alberta ORGANization Group, Edmonton, AB, Canada.

Abstract

The coronavirus 2019 (COVID-19) pandemic has disrupted health systems worldwide, including solid organ donation and transplantation programs. Guidance on how best to screen patients who are potential organ donors to minimize the risks of COVID-19 as well as how best to manage immunosuppression and reduce the risk of COVID-19 and manage infection in solid organ transplant recipients (SOTr) is needed.

Methods: Iterative literature searches were conducted, the last being January 2021, by a team of 3 information specialists. Stakeholders representing key groups undertook the systematic reviews and generation of recommendations using a rapid response approach that respected the Appraisal of Guidelines for Research and Evaluation II and Grading of Recommendations, Assessment, Development and Evaluations frameworks.

Results: The systematic reviews addressed multiple questions of interest. In this guidance document, we make 4 strong recommendations, 7 weak recommendations, 3 good practice statements, and 3 statements of "no recommendation."

Conclusions: SOTr and patients on the waitlist are populations of interest in the COVID-19 pandemic. Currently, there is a paucity of high-quality evidence to guide decisions around deceased donation assessments and the management of SOTr and waitlist patients. Inclusion of these populations in clinical trials of therapeutic interventions, including vaccine candidates, is essential to guide best practices.