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COVID-19

The Health Resources and Services Administration (HRSA) Division of Transplantation (DoT) is monitoring the impact of the coronavirus (COVID-19) public health emergency on organ procurement and transplantation.

Frequently asked questions and answers on organ donation and transplantation can be found here.

Despite the widespread disruption to healthcare providers in many areas of the United States caused by the pandemic, deceased organ donation and transplants from deceased donors again set annual records in 2020 and continued longstanding trends of increase. However, many transplant programs curtailed their living donor transplants for a period of time, and a number of transplant hospitals continue to make alternate arrangements for evaluation, testing and medical follow-up of transplant candidates and recipients.

If you are a transplant candidate or recipient and you have been told your transplant program is temporarily changing its usual arrangements, your program is your best contact for information regarding their facility status, appointment scheduling, and availability of critical services. If you need additional information, contact the toll-free OPTN Patient Services line, (888) 894-6361.

Operational actions

The OPTN Executive Committee, on behalf of the OPTN Board of Directors, has taken a number of actions to help OPTN members document COVID-19 issues affecting organ donation and transplantation and to help members focus needed resources on essential clinical services in the short term. As circumstances have changed, some of these actions have been made permanent; others have been discontinued or are scheduled to end. The status of each implemented action is listed below.

ActionStatus

Effective May 27, 2021, OPOs must test lower respiratory samples for COVID-19 in all potential lung donors and have results available prior to transplant of the lungs.

The OPTN Executive Committee approved this measure on April 26, 2021, as an emergency action. It will be considered for retrospective public comment. Read here for details.

The required submissions of living donor follow-up (LDF), organ-specific transplant recipient follow-up (TRF), and recipient malignancy (PTM) forms due beginning March 13, 2020, were temporarily suspended.

Follow-up forms due on or after April 1, 2021, are again subject to usual OPTN policy requirements. Transplant hospitals will have until July 1, 2021, to submit forms previously placed in “amnesty” status. Read here for details.

The OPTN Membership and Professional Standards Committee (MPSC) evaluated specific areas of monitoring in light of the changes member institutions had to make due to the pandemic. As a result, the MPSC implemented several time-limited emergency changes to member monitoring.

On March 25, 2021, the MPSC agreed to resume monitoring of transplant program functional activity and patient notification requirements, effective July 1, 2021. All updates to monitoring changes may be found in a supplement to the OPTN member evaluation plan on the OPTN compliance page.

Transplant programs must submit current data to the OPTN to support transplant candidates’ listing or waiting time. Beginning in March 2020, the OPTN instructed transplant programs that if they are unable to collect updated data due to issues related to COVID-19, or if in their medical judgment they opt not to collect updated data because of COVID-19 considerations, programs may report the most recent clinical data values they had previously submitted.

As transplant programs have adopted new protocols to protect their patients during the pandemic, use of the provision has declined over time. The OPTN Executive Committee has voted to repeal this action effective July 27, 2021. Read here for details.

The semi-annual transplant program-specific reports (PSRs) and organ procurement organization (OPO)-specific reports (OSRs) published by the Scientific Registry of Transplant Recipients will be adjusted for the July 2021 reporting cycle. These changes were developed in coordination with the Organ Procurement and Transplantation Network’s Membership and Professional Standards Committee, which evaluates and supports OPTN members by providing feedback on and recommendations to improve members’ performance, compliance and quality systems. Read the announcement.

These decisions will apply to the evaluations released in the SRTR’s semi-annual program-specific reports scheduled for release on July 6, 2021. These decisions will then be re-evaluated as more information becomes available in preparation for the release scheduled for January 2022.

Data fields have been added to DonorNet® to indicate whether COVID-19 testing has been performed on deceased donors, with related information including test methodology and results.

The OPTN Board of Directors made these data fields permanent and required at its meeting Dec. 7, 2020. Read here for details.

If a kidney transplant program evaluates and intends to register a transplant candidate who has not initiated dialysis, but the program is temporarily unable to complete their registration due to COVID-19 considerations, they are able to modify their candidate’s wait time initiation date later.

This measure remains in effect, subject to ongoing review of its applicability and effectiveness.

A candidate temporarily inactive reason code, “COVID-19 precaution,” was added to WaitlistSM to address instances where a transplant program opts to temporarily defer organ offers for a transplant candidate due to issues relating to the COVID-19 outbreak.

Doing so does not mean that the candidate is being removed from the transplant waiting list. It means that offers must be temporarily deferred for that patient because of program- or patient-related circumstances. The transplant program may reactivate the candidate at any time it is again ready to consider the individual to receive organ offers.

This measure remains in effect, subject to ongoing review of its applicability and effectiveness.

A cause of death code, “Infection: Viral – COVID-19,” was added to WaitlistSM and TIEDI® to allow transplant program staff to more accurately report data. This code allows for better assessment of the impacts of the COVID-19 pandemic on transplant candidates and recipients.

This measure remains in effect, subject to ongoing review of its applicability and effectiveness.

Effective March 25, 2020, three new refusal codes were established to document refusal of an organ offer for a transplant candidate for COVID-19-related reasons:

  • Refusal code 840: COVID-19 candidate-related reason
  • Refusal code 841: COVID-19 donor-related reason
  • Refusal code 842: COVID-19 OPO or transplant hospital operational issue
This measure remains in effect, subject to ongoing review of its applicability and effectiveness.

COVID-19 has been added to the list of pathogens of special interest, which should be reported to the OPTN Improving Patient Safety Portal if there is a suspected instance of disease transmission from donor to recipient.

This measure remains in effect, subject to ongoing review of its applicability and effectiveness.

The OPTN launched an interactive forum in April 2020 for OPTN members to engage on topics specific to donation and transplant during COVID-19. It was designed to allow donation and transplant professionals to collaboratively discuss, organize, catalog and archive the learnings and insights developed during the pandemic.

The collaborative forum closed in July 2020. Public webinars developed as part of the collaborative were recorded and continue to be available (see “Webinars” below).

Additional resources

The OPTN has released a Summary of Evidence on SARS-CoV-2 donor evaluation and testing, as well as organ recovery from donors with a history of COVID-19. Compiled by the OPTN Ad Hoc Disease Transmission Advisory Committee (DTAC), the document includes the latest information known for minimizing the risk of donor-derived COVID-19 transmission while maximizing donor utilization.

Learn more about the care of transplant candidates and recipients, as well as the screening of potential organ donors at risk of COVID-19, from the following organizations:

Webinars

In a series of webinars coordinated by the OPTN, transplant and OPO professionals share effective practices related to organ recovery and transplantation during COVID-19. These webinars may provide guidance to the donation and transplant community.

Telemedicine, transplant, and COVID-19: One transplant center’s experience

Pooja Singh, M.D., offers her perspectives on the potential benefits and challenges involved with telemedicine — an approach to care delivery that, given COVID-19, has become increasingly important. Dr. Singh is medical director of the kidney-pancreas transplantation and living donor kidney transplant programs at Jefferson Transplant Institute, Thomas Jefferson University Hospitals. This webinar was original recorded May 7, 2020.

View the presentation slides

COVID-19: Past, present and future OPO operations

Leaders of four OPOs discuss issues related to organ procurement operations during COVID-19, and how they are addressing responses to the pandemic. This webinar is intended for donation and transplant audiences. As programs are building new processes in response to the pandemic, they are assessing staffing models, staff and patient safety, workspace configuration and a range of operational processes. Panelists are Charlie Alexander, president and CEO, The Living Legacy Foundation of Maryland; Kevin O’Connor, president and CEO, LifeCenter Northwest; Jeff Orlowski, president and CEO, LifeShare of Oklahoma; and Jennifer Prinz, COO, Donor Alliance. This webinar was originally recorded June 11, 2020.

View the presentation slides

COVID-19: Past, Present and Future Transplant Center Operations

Three transplant administrators discuss issues related to transplant hospital operations during COVID-19. This webinar is intended for donation and transplant audiences. As programs are building new processes in response to the pandemic, they are assessing staffing models, staff and patient safety, workspace configuration and a range of operational processes. Panelists are Brigitte Sullivan, executive director, NYU Langone Transplant Institute; Angie Korsun, executive director, Advanced Organ Management Services, Banner-University Medical Center Phoenix and Banner-University Medical Center Tucson; and Jennifer Milton, chief administrative officer, UT Health San Antonio. This webinar was originally recorded July 24, 2020.

View the presentation slides