TABLE 3.

A potential guidance to phasing up transplant activity during the pandemic

Transplant restart level	Description of conditions	Description of activity
Restart phase 1: limited increase in activity	A significant flattening of the pandemic curve is observed in the jurisdiction. This includes a stable number of new cases; and some stabilization in ward/ICU bed utilization	• Kidney TRANSPLANT ○ No living donor activity; ○ Allow NDD-SCD deceased donors to recipients based on waitlist priority ○ Medically urgent and HSP recipients (PRA >= 95%) eligible for all NDD-SCD, NDD-ECD and selected DCD donors • Liver transplant ○ Living donor activity for moderate to severe sick recipients only ○ Deceased donor activity; NDD; DCD < age 50 • Heart transplant ○ High status heart patients only; defer if stable on LVAD • Lung transplant ○ High status patients only; NDD donors • Pancreas and kidney-pancreas transplant ○ NDD- SCD and DCD < age 35 activity for SPK; no PAK or PTA activity • Small bowel transplant ○ No activity unless combined with liver
Restart phase 2: moderate increase in transplant activity	The number of new COVID cases is flat or decreasing for a period of time (eg, >2 weeks) and ICU and ward bed utilization has been at a stable level for >2 weeks at the transplant hospital	• Kidney transplant ○ Very selected living donor activity (imminent dialysis in a pre-emptive transplant); ○ Allow NDD-SCD, NDD-ECD, and selected DCD donors to recipients based on waitlist priority • Liver transplant ○ Living donor activity for moderate to severe sick recipients only ○ Deceased donor activity as normal for NDD and DCD • Heart transplant ○ High status; low status only if institution/ICU capacity allows • Lung transplant ○ Moderate to high status recipients, NDD, DCD donors • Pancreas and kidney-pancreas transplant ○ NDD-SCD; DCD < age 50 activity for all SPK and; PAK recipients; no PTA activity • Small bowel transplant ○ No activity unless combined with liver
Restart phase 3: near normal transplant activity	Prolonged stability and/or decreases in COVID activity is observed along with prolonged stability or decreases in hospital ICU/ward bed utilization. ICUs are running consistently below capacity at transplant hospital	• Kidney transplant ○ A slow phase up of living donor activity ○ Resume regular jurisdiction-based allocation algorithm for NDD and DCD deceased donor kidneys • Liver transplant ○ Living donor activity as normal with some priority to sicker recipients ○ Deceased donor activity as normal • Heart transplant ○ Normal activity • Lung transplant ○ All status patients, NDD, DCD donors as per normal criteria • Kidney-pancreas transplant ○ Normal activity • Small bowel transplant ○ Deceased donor activity as normal a

Abbreviations: NDD, neurological determination of death; DCD, donation after cardiocirculatory death; ECD, exceptional criteria donor; SCD, standard criteria donor; PRA, panel reactive antibody; SPK, simultaneous pancreas-kidney; PAK, pancreas after kidney; PTA, pancreas transplant alone; LVAD, left ventricular assist device.

^aModified from Trillium Gift of Life Network (TGLN) Ontario criteria for phased restart of transplant activity. The Table is provided only as a rough guidance to programs and should take into account other jurisdictional issues.