Obtaining tissues and organs for transplantation and coronavirus infections: a scoping review

Pessoa, João Luís Erbs; Knihs, Neide da Silva; Magalhães, Aline Lima Pestana; Paim, Sibele Maria Schuantes; Wachholz, Laísa Fischer; Roza, Bartira de Aguiar

doi:10.1590/0034-7167-2020-0610

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REVIEW • Rev. Bras. Enferm. 74 (Suppl 1) • 2021 • https://doi.org/10.1590/0034-7167-2020-0610 copy

Obtaining tissues and organs for transplantation and coronavirus infections: a scoping review

Obtención de tejidos y órganos para trasplante e infecciones por coronavirus: revisión de alcance

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to map the care recommendations available in the literature capable of supporting health professionals’ decision-making in the organ and tissue donation process before the COVID-19 pandemic.

Methods:

is a nine-step scoping review with searches performed in three databases and an electronic library (Science Direct).

Results:

873 publications were retrieved, 15 selected for analysis. All were published in 2020, originating mainly on China, with predominance of original articles. The most frequent recommendations relate to testing to detect SARS-CoV-2 infection for deceased donors (52.6%) and clinical evaluation of potential donors and possible donors (31.6%).

Final considerations:

it is believed that the recommendations evidenced will support health professionals in the process of donation and organ transplantations to determine interventions for decision-making during the COVID-19 pandemic.

Descriptors:
Coronavirus Infections; Pandemics; Tissue and Organ Procurement; Organ Transplantation; Donor Selection

Title	Year Country	Design	Objective	Evidence
Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China⁽¹1 Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;39:507-497. https://doi.org/10.1016/S0140-6736(20)30183-5 https://doi.org/10.1016/S0140-6736(20)30... ⁾	2020 China	Exploratory study	To report epidemiological, clinical, laboratory and radiological characteristics, treatment and clinical outcomes of these patients.	Pay attention to computed tomography (CT) of the chest with abnormal findings and acute respiratory distress syndrome. Observe common symptoms: fever, cough, myalgia, or fatigue. Note for less common symptoms: sputum production, headache, dyspnea, and lymphopenia.
Organ donation during the coronavirus pandemic: an evolving saga in uncharted waters⁽⁷7 Moris D, Shaw BI, Dimitrokallis N, Barbas AS. Organ donation during the coronavirus pandemic: an evolving saga in uncharted waters. Transpl Int. 2020. https://doi.org/https://doi.org/10.1111/tri.13614 https://doi.org/https://doi.org/10.1111/... ⁾	2020 USA	Expert opinion study	To discuss care when considering transplantation, considering that coronavirus transmission is affected by epidemiological risk factors, incubation period, degree of viremia and viability of SARS - CoV - 2 in blood and organ compartment.	Perform C-reactive protein (CRP) 24 hours before donation in dead and living donors. Discard the donation of those who are positive for COVID-19. It is suggested to perform bronchoalveolar lavage as it is more sensitive in potential donors. Be extremely careful when considering the need for a transplant and accepting donors. Donation must be declined in asymptomatic individuals who have been in an area affected by COVID-19 in the past 28 days. Asymptomatic individuals monitored after contact with a proven case of COVID-19 are excluded from the donation. Transplants from non-urgent deceased donors and living donors should be suspended. There should be no donation of lungs or small intestine. Low-risk or negative donors for the test, as well as those who have recovered from COVID-19 (more than 28 days), are likely to be considered safe for donation.
Challenges and countermeasures for organ donation during the SARS-CoV-2 epidemic: the experience of Sichuan Provincial People's Hospital⁽¹²12 Pan L, Zeng J, Yang H. Challenges and countermeasures for organ donation during the SARS-CoV-2 epidemic: the experience of Sichuan Provincial People's Hospital. Intensive Care Med [Internet]. 2020. [cited 2020 May 22];46(5):844-5. Available from: https://pubmed.ncbi.nlm.nih.gov/32100062/ https://pubmed.ncbi.nlm.nih.gov/32100062... ⁾	2020 China	Experience report	To report the donation protocol of the Sichuan Province People's Hospital	Laboratory test according to the SARS-CoV-2 and chest CT guidelines before donation. Conduct epidemiological screening for potential donors and their families (travel history and suspected respiratory infections). Evaluate clinical symptoms such as fever, dyspnea, dry cough, diarrhea. During donor maintenance in the ICU, patients should not have contact with patients infected with COVID-19, nor should the team have a history of contact with these patients. The entire team involved in the donation process must have participated in training on epidemiological knowledge related to COVID-19. The team must have been trained in the epidemic situation of the hospital from which donors originate and decide whether to accept donors or not.
The COVID-19 outbreak in Italy: Initial implications for organ transplantation programs⁽¹⁴14 Angelico R, Trapani S, Manzia TM, Lombardini L, Tisone G, Cardillo M. The COVID-19 outbreak in Italy: Initial implications for organ transplantation programs. Am J Transplant [Internet]. 2020[cited 2020 May 22]:5-1. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/ajt.15904 https://onlinelibrary.wiley.com/doi/full... ⁾	2020 Italy	Expert opinion study	To discuss the implications for organ transplantation activity considering the spread of COVID-19.	Perform PCR 24 hours before donation in dead and living donors. All possible donors should be screened for SARS-CoV-2 using PCR with samples of nasopharyngeal swabs or bronchoalveolar lavage fluids. Only donors without COVID-19 are considered for organ donation. In the case of transplantation with extreme urgency, exclude infection by COVID-19 in both donors and recipients.
COVID-19: A global transplant perspective on successfully navigating a pandemic⁽¹⁵15 Kumar D, Manuel O, Natori Y, Egawa H, Grossi P, Han SH, et al. COVID-19: a global transplant perspective on successfully navigating a pandemic. Am J Transplant [Internet]. 2020[cited 2020 May 22];00:7-1. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC72283 01/pdf/AJT-9999-na.pdf https://www.ncbi.nlm.nih.gov/pmc/article... ⁾	2020 Canadá	Expert opinion study	To discuss mitigation strategies, such as donor screening, resource planning, and a step-by-step approach to transplant volume considerations as local resource issues require.	Pay attention to the false negative rates of the tests, which may be due to inadequate collection or incubation period. Living and deceased donors should be tested for SARS-CoV-2. Before deciding to perform the transplant, consider: (1) introducing immunosuppression in patients in the middle of a pandemic; (2) the risk versus benefit ratio of postponing the transplant; (3) the rationing of health resources, including hospital and outpatient resources. In cases of liver transplantation, patients can be stratified based on the MELD score and the decision to transplant only patients with high MELD. Always evaluate priority level.
Immediate impact of COVID-19 on transplant activity in the Netherlands⁽²²22 Vries APJ, Alwayn IPJ, Hoek RAS, Berg APVD, Ultee FCW, Vogelaar SM, et al. Immediate impact of COVID-19 on transplant activity in the Netherlands. Transp Immunol. 2020;7-1. https://doi.org/10.1016/j.trim.2020.101304 https://doi.org/10.1016/j.trim.2020.1013... ⁾	2020 Holanda	Expert opinion study	To detail the response of the Dutch transplant community to COVID-19 and the immediate consequences for transplant activity.	Implement the SARS-CoV-2 test for all deceased donors. It is suggested that the SARS-CoV-2 test be performed with endotracheal sputum. Perform CT in case of patients with a previous history and negative nasopharyngeal swab. Consider carrying out each transplant with caution. In liver transplantation, focus on patients with high urgency and those with Final Phase Liver Disease (MELD)> 20.
Dramatic impact of the COVID-19 outbreak on donation and transplantation activities in Spain⁽²³23 Domínguez-Gil B, Coll E, Ferrer-Fàbrega, Briceño J, Ríos A. Dramatic impact of the COVID-19 outbreak on donation and transplantation activities in Spain. Cir Espan. 2020;6-1. https://doi.org/10.1016/j.ciresp.2020.04.012 https://doi.org/10.1016/j.ciresp.2020.04... ⁾	2020 Spain	Expert opinion study	To elucidate the recommendations issued by the Spanish system for the evaluation and selection of organ donors with respect to SARS-CoV-2 infection and report the impact of the COVID-19 epidemic on the donation and transplantation activity in Spain.	Potential donor must perform PCR exam 24 hours prior to extraction. In case of cured patients, wait 21 days after the cure for the donation to occur. In case of exposure to a confirmed case of COVID-19, wait 21 days. Potential donor with clinical standard compatible with COVID-19, exclude donation. Potential donor who does not show compatible symptoms, but there is suspicion, perform the test for SARS-CoV-2 and discard the donation if positive.
Coronavirus disease 2019 and transplantation: A view from the inside⁽²⁴24 Gori A, Dondossola D, Anttonelli B, Mangioni D, Alagna L, Reggiani P, et al. Coronavirus disease 2019 and transplantation: a view from the inside. Am J Transpl. 2020:2-1. https://doi.org/10.1111/ajt.15853 https://doi.org/10.1111/ajt.15853... ⁾	2020 Italy	Expert opinion study	To elucidate the guidelines published by the Italian Transplantation Authority on donor management, as well as describe the preventive measures implemented by a transplant center in Milan.	Perform PCR exam with nasopharyngeal swab (SPL) or bronchoalveolar lavage and exclude positive donors. Carefully evaluate the costs and benefits of performing a transplant during the COVID-19 outbreak. Patient can be infected after hospitalization by health professionals and other close contacts. Thus, there is a need for great caution to accept donors.
Coronavirus disease 2019: Utilizing an ethical framework for rationing absolutely scarce health-care resources in transplant allocation decisions⁽²⁵25 Wall AE, Pruett T, Stock P, Testa G. Coronavirus disease 2019: utilizing an ethical framework for rationing absolutely scarce health-care resources in transplant allocation decisions. Am J Transpl. 2020;00:5-1. https://doi.org/10.1111/ajt.15914 https://doi.org/10.1111/ajt.15914... ⁾	2020 USA	Expert opinion study	To discuss how to transition from traditional consideration versus utility in organ allocation to a more subtle allocation scheme based on ethical values that drive decisions in times of absolute scarcity.	Test all donors. However, even with universal donor testing, there will be false negatives. A negative test does not guarantee zero risk of transmission from donors to recipients. Evaluate the viability of the transplant before COVID-19, question the structure, ethical values of decision-making, risk-benefit ratio, immunosuppression. Can we recommend that a dead donor take priority over a living individual who needs ICU care and mechanical ventilation?
Donor organ evaluation in the era of coronavirus disease 2019: A case of nosocomial infection⁽²⁶26 Krishan J, Tina RNK, Dael G, Lawrence C, Fardad E, Jon AK, Jignesh K. Donor organ evaluation in the era of coronavirus disease 2019: a case of nosocomial infection. J Heart Lung Transpl. 2020. https://doi.org/10.1016/j.healun.2020.04.005 https://doi.org/10.1016/j.healun.2020.04... ⁾	2020 USA	Experience report	To report a case of hospital infection during the investigation for organ donation.	Chest CT assists in the decision to accept the organ until the PCR result is available. The RT-PCR multimodality test should also be considered, as the virus may be present in areas of the mucosa, such as in the intestine. Pay attention to cases in which patients arrive asymptomatic and can acquire COVID-19 upon admission.
Early impact of COVID-19 on transplant center practices and policies in the United States⁽²⁷27 Boyarsky BJ, Po-Yu Chiang T, Werbel WA, Durand CM, Avery RK, Getsin SN, et al. Early impact of COVID-19 on transplant center practices and policies in the United States. Am J Transpl ant. 2020:10-1. https://doi.org/10.1111/ajt.15915 https://doi.org/10.1111/ajt.15915... ⁾	2020 USA	Exploratory study	To understand the impact on transplantation activity in the United States and the variation at the central level of testing, clinical practice and policies.	Test all low-risk donors for COVID-19 by PCR. All high-risk donors test for PCR and BAL NAT. There is a nosocomial and community spread in progress for potential deceased donors.
Classification of the cutaneous manifestations of COVID-19: a rapid prospective nation wide consensus study in Spain with 375 cases⁽²⁸28 Casas CG, Catalá A, Hernández GC, Rodríguez-Jiménez P, Nieto DF, Lario ARV. Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases. Br J Dermatol. 2020. https://doi.org/10.1111/bjd.19163 https://doi.org/10.1111/bjd.19163... ⁾	2020 Spain	Exploratory study	To describe the cutaneous manifestations of COVID-19 disease and relate it to other clinical findings.	Look out for vesicular lesions in middle-aged COVID-19 patients. The presence of pruritus was very common in urticarial and maculopapular lesions. An increase in the number of herpes zoster cases has been noted. Pay attention for any skin lesions that may arise. If an injury is identified, further screening for COVID-19 is necessary.
Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China⁽²⁹29 Zhang JJ, Dong X, Cao YY, Yang YB, Yan YG, Akdis CA et al. Clinical characteristics of 140 patients infected with SARS‐CoV‐2 in Wuhan, China. Allergy. 2020:12-1. https://doi.org/10.1111/all.14238 https://doi.org/10.1111/all.14238... ⁾	2020 China	Exploratory study	To investigate clinical characteristics and allergic status of patients infected with SARS-CoV-2.	Observe signs of bilateral frosted glass or irregular opacity in radiological findings. The presence of lymphopenia and eosinopenia may be indicative of COVID-19. Loss of smell, fever, fatigue and gastrointestinal symptoms may indicate COVID-19. When one of these symptoms is noticed in patients, a more prolonged and detailed investigation is necessary.
Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province⁽³⁰30 Kui L, Yuan-Yuan F, Yan D, Wei L, Mei-Fang W, Jing-Ping M, et al. Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province. Chin Med J. 2020;133(9):1031-25. https://doi.org/10.1097/CM9.0000000000000744 https://doi.org/10.1097/CM9.000000000000... ⁾	2020 China	Exploratory study	To analyze the clinical characteristics, treatment regimens and prognosis of patients infected with COVID-19.	Pay attention to chest CT with lesions in multiple lung lobes. Watch for fever, cough, pain or muscle fatigue, in addition to lymphocytopenia. If these findings are identified, investigate for COVID-19.
Clinical Characteristics of Coronavirus Disease 2019 in China⁽³¹31 Guan WJ, Ni, ZY, Hu Y, Liang WH, Ou CQ, He JX et al. Clinical characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382:1720-08. https://doi.org/10.1056/NEJMoa2002032 https://doi.org/10.1056/NEJMoa2002032... ⁾	2020 China	Exploratory study	To describe the results of an analysis of the clinical characteristics of COVID-19 in a selected cohort of patients in China.	Observe chest CT: ground-glass opacity was the most common radiological finding. Signs of lymphocytopenia, fever at admission and during hospitalization and cough.

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[1] Corresponding author: João Luís Erbs Pessoa E-mail: joaoerbs@gmail.com