TABLE 2.

Phased approach to new transplant activity during the COVID-19 pandemic

Transplant activity level	Priority level description	Examples (may include but not limited to)
25% reduction in transplant activity	Elective cases. Patients whose conditions is deemed nonlife threatening or can be managed with medication and for whom services can be deferred until the end of a pandemic wave (ie, 6-8 wk)	• Kidney transplant a No living donor activity b Deceased donor activity allowed • Liver transplant a No living donor activity for stable recipients b Deceased donor activity allowed •Heart—normal activity •Lung—normal activity • Kidney-pancreas/pancreas alone transplant a K/P activity allowed b PAK or PTA not allowed • Islet transplant a No activity • Small bowel a No activity • Keratolimbal a No activity
50% reduction in transplant activity	Urgent cases. Patients who are deemed urgent and who need service within 14 d. It may be possible to defer these services for a few days, but not for the length of a pandemic wave. Physicians will determine that these patients are not put at undue risk. If their situation changes they will be changed to emergent	• Kidney transplant a No activity except highly sensitized (eg, PRA of 95% or above with suitable donor offer and negative DSA) • Liver transplant a Activity for MELD > 25 b No living donor activity for stable recipients • Heart a Only intermediate status patients and above • Lung a All patients allowed b Defer if patient is stable on waitlist • Kidney-pancreas transplant a No activity except high PRA as above • Small bowel transplant a No activity • Islet transplant a No activity •No import of organs from select jurisdictions
75% reduction in transplant activity	Emergent cases: Patients who are deemed critical, whose condition is immediately life threatening. Their immediate need is greatest	• Kidney transplant a No activity unless for medically urgent status (eg, lack of dialysis access, uremic cardiomyopathy, uremic neuropathy with paralysis and/or respiratory compromise) • Liver transplant a Only fulminant hepatic failure or MELD > 30 • Heart transplant a Highest status only (eg, status 3, 3.5, and 4 in Canada) • Lung transplant a Only rapidly deteriorating and status 2 patients (use LAS in US) • Kidney-pancreas transplant a No activity • Small bowel transplant a No activity • Islet transplant a No activity •No import of organs from select jurisdictions
100% reduction in transplant activity	Health system is overwhelmed with COVID-19; no ICU or other capacity available; severe shortages of health personnel	•Halt of all living and deceased donor transplant activity

Abbreviations: ICU intensive care unit; LAS, lung allocation score; MELD, model for end-stage liver disease; PAK, pancreas after kidney; PRA, panel reactive antibody; PTA, pancreas transplant alone.