TABLE 1.

Considerations for performing renal transplants during the coronavirus disease 2019 (COVID-19) viral pandemic

Uncertainties	Proceeding with transplant	Deferring transplant
Evolving novel pathogen pandemic Severity, extent, trajectory, and duration of the pandemic is unknown	•Risk of healthcare-associated, community-acquired or donor-derived infection •Potential adverse psychosocial effects due to heightened infection control measures for recipients (eg, social distancing, prolonged isolation)	•Risk of healthcare-associated (eg, dialysis center) or community-acquired infection •Adverse medical and psychosocial effects from prolonged dialysis (eg, recurrent dialysis access-related complications) •Loss of access to transplantation may be prolonged, with risk of exclusion from transplantation due to disease progression or death •Poorer posttransplant outcomes with prolonged duration on dialysis
Impact of COVID-19 in different population groups (eg, transplant vs dialysis patients)	•COVID-19 may be more severe and potentially fulminant in transplant recipients, especially those with a higher net state of immunosuppression	•Dialysis patients with medical comorbidities are likely also significantly vulnerable to severe COVID-19
Treatment and prophylaxis options not established	•Therapeutics for trial purposes or compassionate use may exclude transplant patients •Risk of drug-drug interaction, especially with immunosuppressants •Reduction of immunosuppression to manage infection may put the graft at risk	•Therapeutics for trial purposes or compassionate use may exclude dialysis patients
Impact on healthcare resources	•Access to resources needed for transplantation may be disrupted •Transplant processes may compete for critical healthcare resources (eg, staff, medical supplies, and facilities) essential for pandemic response	•Access to existing dialysis facilities may be affected
Risks to donor/caregivers	•Risk of acquiring nosocomial COVID-19 in healthy individuals	•Caregivers may be as likely to acquire the infection in the community if widespread transmission occurs