Journal Logo

In View: Special Articles

Additional Suggestions for Organ Donation During COVID-19 Outbreak

Vargas, Maria MD1; Iacovazzo, Carmine MD1; Servillo, Giuseppe MD1

Author Information
doi: 10.1097/TP.0000000000003314
  • Free

COVID-19 is dramatically increasing in Italy, the last report from the Ministry of Health on March 9 reported the presence of 9172 confirmed cases and 733 patients in intensive care unit (ICU).1 On March 3, we admitted in our ICU a 65-y-old male patient with a diagnosis of Fisher IV—subarachnoid hemorrhage due to an arteriovenous malformation of the anterior communicating artery. Despite the attempt of arteriovenous malformation clipping and medical management including intubation, ventilation, mannitol, nimodipine, and close monitoring of blood pressure administrated in ICU, the patient met the criteria of brain death after 24 h.2 Suddenly we started the evaluation of brain death according to the Italian law,3 and, since the patient’s family gave us the consent for organ donation, we informed the local and the national centers for organ recovery. At that time, our hospital had no cases of COVID-19. However, since the Italian and worldwide dramatic spread of this infection,4 we pointed out additional suggestions (1) to evaluate the possible exposures and (2) to protect from potential exposures the organ donor (Table 1).

TABLE 1. - Additional suggestions for organ donation during COVID-19
Additional suggestions for organ donation during COVID-19 a
Organ donor Sudden isolation from other patients to minimize the risk of transmission from unknown COVID-19 cases
COVID-19 testing on bronchoalveolar lavage and nasal cavity specimen
Screening for
 1. domicile, travel, or prolonged stay in the zones where COVID-19 cases were currently recognized
 2. close contact with suspected or confirmed cases of COVID-19
 3. close contact with patients with respiratory symptoms at risk of COVID-19
 4. respiratory symptoms before the ICU admission
Evaluation of the presence of possible COVID-19 respiratory like symptoms
Performance of lung computed tomography to assess the presence of radiological patterns of COVID-19
Limit the access to the isolation room
Permission to access only for healthcare personnel screened for no exposure to COVID-19 and without COVID-19 respiratory symptoms
Allow the access only with personal protective equipment suggested for COVID-19
Organ procurement surgeons Coming from hospitals without COVID-19 cases
Screening for:
 1. domicile, travel, or prolonged stay in the zones where COVID-19 cases were currently recognized
 2. close contact with suspected or confirmed cases of COVID-19
 3. close contact with patients with respiratory symptoms at risk of COVID-19
Absence of possible COVID-19 respiratory symptoms
In case of COVID-19 positive screening and respiratory symptoms → ask for a different surgical team
Travel with dedicated military flights properly disinfected. Avoid the use of commercial flights
Prepare a dedicated operating room
Access to the operating room only with personal protective equipment suggested for COVID-19
aThese suggestions implemented the Italian national guidelines for the organ donation and were closely discussed with the National Center for Organ Donation.
ICU, intensive care unit.

According to our suggestions, the organ donor had no positive history for exposure and no symptoms of COVID-19. During the ICU stay, the organ donor did not develop any COVID-19 respiratory symptoms; we performed a lung computed tomography scan that was negative and, finally, the nasopharyngeal test for COVID-19 returned negative before the organ transplantations. The organs recovered and successfully transplanted were the corneas, heart, liver, and kidneys.

Regarding the healthcare personnel, we limited the access to the organ donor allowing it exclusively to personnel with negative history of exposure, without respiratory symptoms, and properly equipped with personal protective equipment suggested for COVID-19. The same precautions were adopted for the surgical team responsible of the organ procurement.

According to the literature, this is the first case of organ donation after brain death during the COVID-19 outbreak. We hope that our suggestions may improve the safety of organ donor and the safety of transplantation during the worldwide spread of COVID-19 cases.

REFERENCES

1. Ministry of Health. COVID-19—situation in Italy.Available at http://www.salute.gov.it/portale/nuovocoronavirus/dettaglioContenutiNuovoCoronavirus.jsp?lingua=italiano&id=5351&area=nuovoCoronavirus&menu=vuoto. Accessed March 9, 2020
2. Wijdicks EF, Varelas PN, Gronseth GS, et al.; American Academy of Neurology. Evidence-based guideline update: determining brain death in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2010; 74:1911–1918doi:10.1212/WNL.0b013e3181e242a8
3. D. M. 22 AGOSTO 1994, n. 582 (G.U. del 19-10-1994 n.245). Regolamento recante le modalità per l’accertamento e la certificazione di morte.Available at https://www.gazzettaufficiale.it/eli/id/1994/10/19/094G0623/sg. Accessed March 9, 2020
4. Anderson RM, Heesterbeek H, Klinkenberg D, et al. How will country-based mitigation measures influence the course of the COVID-19 epidemic? Lancet. 2020; 395:931–934doi:10.1016/S0140-6736(20)30567-5
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.