Table 1.

Donor and recipient screening and approach to transplant activity.

A. Summary of donor and recipient screening
Deceased donor screening	Living donor screening	Pre transplant screening	Approach to waiting list patient after COVID infection
Universal NAT (NP or BAL^a)	Universal NAT (NP)	Clinical, NAT where testing available For liver, heart and lung: To facilitate the extra time needed for recipient test results to become available, allocation for was initiated before donor SARS-CoV-2 screening result is known	Kidney/pancreas: COVID-19 positive patients could return on the active organ waiting list 2 weeks after resolution of clinical symptoms and negative COVID-19 NP swab PCR Liver: COVID-19 positive patients could return on the active organ waiting list after resolution of clinical symptoms and negative COVID-19 NP swab PCR Heart/Lung: COVID-19 positive patients could return on the active organ waiting list after resolution of clinical symptoms and negative COVID-19 NP swab PCR

B. Step-wise approach to transplant activity
1. Halt of kidney and pancreas transplantation for which T-and/or B cell depleting induction therapy is necessary (ABO and HLA-incompatible and other high immunological risk transplantations; continue for recipients who already started the induction protocol). No islet transplantation. 2. Halt of living donor activity. 3. Deceased donor activity case-by case. 4. Medical urgent and highly immunized only. 5. Pediatric programs followed adult programs.	1. Continue where possible. 2. Focus even more than before on the patients with the highest need, i.e. high-urgent cases, those with MELD >20, or with otherwise life-threatening disease such as hepatocellular carcinoma approaching borders of Milan criteria. 3. Stable patients are put temporarily on non transplantable status. 4. Living-donor pediatric liver transplantation continues. Transplant across the ABO blood group barrier in small children.	1. Continue where possible. 2. Due to limited HLTx capacity: urgent cases with low life expectancy if not transplanted. 3. Pediatric programs followed adult programs.

B. Step-wise approach to transplant activity

Kidney/Pancreas/Islet transplantation

Liver transplantation

Heart Lung Transplantation

1.
Halt of kidney and pancreas transplantation for which T-and/or B cell depleting induction therapy is necessary (ABO and HLA-incompatible and other high immunological risk transplantations; continue for recipients who already started the induction protocol). No islet transplantation.
2.
Halt of living donor activity.

1.
Continue where possible.
2.
Focus even more than before on the patients with the highest need, i.e. high-urgent cases, those with MELD >20, or with otherwise life-threatening disease such as hepatocellular carcinoma approaching borders of Milan criteria.
3.
Stable patients are put temporarily on non transplantable status.
4.
Living-donor pediatric liver transplantation continues. Transplant across the ABO blood group barrier in small children.

1.
Continue where possible.
2.
Due to limited HLTx capacity: urgent cases with low life expectancy if not transplanted.
3.
Pediatric programs followed adult programs.

Abbreviations: NAT, nucleic acid testing; BAL, bronchoalveolar lavage; NP, nasopharyngeal; PCR, Polymerase Chain Reaction.

BAL was preferred.