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Information for transplant programs and OPOs regarding 2019 Novel Coronavirus

The recent outbreak of a novel coronavirus (2019-nCoV) in Wuhan, Hubei Province, China and the finding of infection in many other countries including the United States has led to questions among transplant programs, Organ Procurement Organizations (OPOs) and patients.  The Organ Procurement and Transplantation Network (OPTN) strives to provide up-to-date information to answer these questions and to provide guidance as needed.  Accordingly, the OPTN Ad Hoc Donor Transmission Advisory Committee (DTAC), American Society of Transplantation (AST) and the American Society of Transplant Surgeons (ASTS), after careful review of information available from the Centers for Disease Control and Prevention (CDC), offers the following information to transplant programs and OPOs in light of these concerns.

General Information

On December 31, 2019, an outbreak of pneumonia in Wuhan, China was reported to the World Health Organization (WHO).  Shortly thereafter it was identified as a novel coronavirus referred to as 2019-nCoV.  In the early part of the outbreak, infected people appeared to have a link to a large seafood and animal market suggesting a zoonotic source.  Subsequently, it appears that it can also be transmitted person-to-person, most likely from respiratory droplets.  Further investigation is ongoing so that more details on its origin and mode of transmission are anticipated.

The infection spread beyond China in early January 2020 to other parts of Asia with cases also identified in Europe and Australia.  Subsequently, several individuals, returning to the United States and Canada from Wuhan, China were also identified as being infected.  

CDC continues to work closely with WHO to monitor the situation and frequently update information that can be accessed at https://www.cdc.gov/coronavirus/2019-ncov/index.html.

 

CDC is also conducting entry screening of passengers on direct and connecting flights from Wuhan, China to airports in the United States.

In addition, the ex-officio DTAC member from CDC is keeping OPTN abreast of new developments.  

Risk of Transmission

Deceased and Living Donors

At this time, transmission of this virus has not been reported through transfusion of blood products, tissues, or organ transplantation.  However, OPOs should continue to focus on epidemiologic risk factors, including a detailed travel history particularly in the prior two weeks to areas where 2019-nCoV is known to be circulating such as the Hubei Province, China or exposure to someone known or suspected of being infected with this Novel Coronavirus.

For potential living donors, a temporary delay in donation should be considered if the donor has traveled within the preceding 14 days to an area where CDC has greater than a Level 1 travel health notice or has had a contact with an individual being evaluated for 2019-nCoV.

Transplant Recipients

The risk of transmitting the disease through solid organ transplantation is not known at this time.  It may be anticipated that similar to other infections, infection with 2019-nCoV may be more severe in immunocompromised hosts such as recipients of a solid organ transplant and readily transmissible to others. 

  • CDC recommends that travelers avoid non-essential travel to Hubei Province, China, including Wuhan.  Chinese officials have closed transport within and out of Wuhan and other areas of Hubei Province, including buses, subways, trains, and the airport.  There may be limited access to adequate medical care in affected areas.  Remain alert if traveling to other parts of China by practicing the precautions below.

Symptoms

Symptoms of lower respiratory disease reported from 2019-nCoV include:

  • fever
  • cough
  • shortness of breath

Respiratory symptoms have ranged from mild to severe.

The incubation period appears to range from 2 to 14 days.

Transplant programs should keep in mind that immunosuppressed persons may not mount a fever.  Accordingly, clinical judgement should be used in evaluating transplant recipients who have been in contact with a person being investigated for infection with 2019-nCoV or who have symptoms and have traveled to an area where 2019-nCoV is circulating.

Treatment:

  • At this time there is no FDA-approved specific antiviral medication for 2019-nCoV
  • Treatment is supportive

Prevention: 

  • There is no FDA-approved vaccine available to protect against 2019-nCoV
  • The most effective preventive measure is avoidance of exposure to the virus.  While in the United States there is a low risk of the spread of 2019-nCoV other people it is always good to remember to use standard precautions against all respiratory viruses
    • Wash hands frequently.
    • Avoid touching eyes, nose, or mouth with unwashed hands.
    • Avoid contact with ill people.
    • Cover your cough or sneeze with a tissue and then throw it in the trash.
    • Clean and disinfect frequently touched objects and surfaces.
    • Keep up to date on all recommended immunizations including annual influenza vaccine.
    • Teach children or close contacts cough-and-sneeze etiquette

Precautions to Implement for Transplant Programs with a patient suspected of being infected with 2019-nCoV

Although transmission dynamics have yet to be determined, follow these CDC recommendations if evaluating a patient suspected of having 2019-nCoV:

  • Mask the patient.
  • Move the patient to a private room with the door closed.  If available, place the patient in an airborne infection isolation room.
  • Use airborne and contact precautions with face shield when entering the patient room.
  • If you suspect infection with 2019-nCoV, report concern to your local infection prevention personnel and local health department immediately.
  • Follow updated guidelines from :

We encourage the transplant community to stay vigilant at this time.  Given the evolving understanding of the epidemiology of 2019-nCoV we encourage reporting of any recognized donor or recipient infection.