Table 4.

Clinical approach to living and deceased donor sand recipients during the coronavirus disease 2019 pandemic

Clinical Approach
Donor assessment
1. Deceased and living donor transplant activity should be assessed at each center on the basis of COVID-19 pandemic severity at their region.
2. One sample from the respiratory tract by RT-PCR for SARS-CoV-2 should be performed within 3 days of procurement. A second viral test be performed 24 hours after the initial test and within 24–48 hours of procurement when feasible.
3. For donors previously known to have had COVID-19, it is suggested the initial COVID-19 infection occurred between 21 and 90 days before donor evaluation, irrespective of repeat NAT test results, and at least 30 days passed after symptom resolution.
4. Chest computerized tomography should be negative for COVID-19 suspicious pneumonia.
5. Consideration should be given toward ensuring lower cold ischemia times to minimize delayed graft function.
6. For living donors who were previously known to have had COVID-19, ≥30 days should have passed after all symptoms were resolved.
7. Living donors should be vaccinated for SARS-CoV-2 before transplantation.
Recipient assessment
1. Patients aged >65years, especially if they have additional comorbidities such as cardiovascular disease and diabetes mellitus, transplantation could be deferred at the peak of pandemics.
2. Transplantation in patients who are highly sensitized with use of antithymocyte globulin and/or rituximab should be assessed patient by patient, considering the recipient’s age and other comorbidities, degree of HLA-matching and mismatching, and severity of the pandemic at the region.
3. For recipients who were previously known to have had COVID-19, at least 30 days should have passed after all symptoms were resolved and should have an updated cardiac and pulmonary assessment before they are considered for transplantation.
4. Patients ideally should be vaccinated for SARS-CoV-2 before transplantation.

COVID-19, coronavirus disease 2019; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; NAT, nucleic acid amplification technique.