Describing out-brake as a pandemic, the organ transplant activity run into danger. Looking on the bright side, the experience from reviews of previous outbreaks on severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) suggests that immunosuppressed patients are not associated with higher risk of fatal complications compared to general population (2,6).
Our National pandemic coordination board, Ministry of Public Health, released recommendations for limiting all planned surgery; so we focused on more urgent patients, preserved the sources to more needy ones and tried to prevent potential spread among healthcare workers and families of patients. However, answer to whether transplant surgery should be performed or not is going to be diverse depending on the situation and epidemiology of virus in your area. We emphasized waitlist mortality risk and potential benefit for all listed hospitalized or at home patients, and identified selected patients that should not be postponed and also accepted good quality organs from proven donors to reduce long ICU stay and early graft dysfunction. In the light of an epidemiological study from Ren et al. (4), which showed that transplant patients taking appropriate precautions had low rate of COVID-19 infection, we evaluated our hospitalized patients and directed the medically stable ones on self-isolation at home. And it’s just as well that we managed to perform transplantation in one of our self-isolated patients. We also considered alternatives like left ventricular assist devices; nevertheless, it should not be utilized in elective patients in order to limit resources or to avoid nosocomial infections (7).
Recent study from Italy showed stable transplantation activity in contrast to our decreasing donor activity (75%) compared to first quarter of last year (3). We aren’t there yet every organ donor is routinely testing. Our protocol for the patients requiring HTx: 1. CT and rapid PCR for already hospitalized patients, 2. Clinical evaluation and CT for patients waiting at home, 3. Patients in elective list must transported privately and accompanied by one and same relative all the time, 4.Recipients and relatives were re-tested and received education for preventative precautions prior to discharge, 5.Donor must have no history of contact with suspected or confirmed COVID-19 patient and of travelling abroad over the past 30 days. 6. Donor must have no signs of pneumonia in CT or no positive nasopharyngeal swab result for COVID-19. 7. Separate the operation room, ICU and postoperative ward to avoid in-hospital disease transmission, 8. Organize shift schedule for related medical staff 9. Immunosuppressive therapy should be continued unless otherwise indicated to reduce or discontinue doses. Our detailed approach to heart transplantation during global pandemic has been described in Fig. 1. Donors who are positive for both clinical and epidemiological screenings are considered high risk to be used for transplantation. If donor was tested positive for COVID-19, the organs should not be used for transplant. In particular, CT has been widely recommended to clarify patients with suspected COVID-19 . However, during global pandemic, the identification of COVİD-19 pneumonia from pulmonary edema caused by heart failure was one of the major challenges for physicians. Most of the radiological features presented with COVID-19 can be seen in many systemic processes and multiple underlying medical comorbidities, concomitant infections and volume overload could influence the CT findings.
Eventhough fatality rate is low (1-8.6%), patients with cardiac comorbidities present more severe outcome of COVID-19 (3). We believe that patients having HTx are already used to social distancing and applying sanitization measures. Sharing knowledge and transparency with patients and other centers are important to come out with less damage through this pandemic.