April 5, 2020 Update

Beatriz Domínguez-Gil, Elisabeth Coll
Organización Nacional de Trasplantes, Madrid, Spain

Spain has been one of the most affected countries by the COVID-19 outbreak. As of 5 April 2020, the number of confirmed cases is 135,032, including 40,437 patients recovered, 6,931 having required admission to the intensive care unit (ICU), and 13,055 deaths, with a global mortality of 9.7%.¹The country is considered at epidemiological scenarios ³ (sustained community transmission) and ⁴ (intensive care capacity saturated and health-care system overwhelmed), as described by the European Centre for Disease Control and Prevention.

² The Spanish donation and transplantation system first focused on safety issues related to COVID-19. Since January 2020, national recommendations for donor evaluation and testing have been issued, that have rapidly evolved over time.3 Donation does not proceed in confirmed cases of COVID-19 or in potential donors with a compatible clinical picture even if not confirmed. In potential donors with epidemiological risk (exposure to a confirmed case of COVID-19 and/or visit to affected area during the previous 21 days), donor screening for SARS-CoV-2 by RT-PCR is performed and donation does not proceed in case of a positive or inconclusive result. Testing is also extended to potential donors with no epidemiological risk if donation of lung and/or small bowel is considered, or if they present symptoms compatible with COVID-19. For cured COVID-19 cases, a minimum period of 21 days after recovery following a cautious case by case risk/benefit assessment is required. In live donation, surgery is deferred for 21 days in donors with epidemiological risk. The deferral period of 21 days has been set to rule out potential outliers beyond the known incubation period of COVID-19. Samples from the upper (nasopharyngeal AND oropharyngeal swab) OR the inferior respiratory tract (preferentially, bronchoalveolar lavage) are used for donor screening. Patients must also be tested for SARS-CoV-2 prior to transplantation.

As Spain was entering in scenarios 3-4, the main issue has been the impact of the epidemic on donation and transplantation activities, because of the saturation of the health-care system and of the ICU capacity, and of concerns about the transmission of the infection to recipients in the post-transplant period (within the hospital or in the community). Centers in the most affected areas have been instructed to pursue donation at least from optimal donors and to focus transplantation activities on critically ill patients and those with difficulties to access transplantation, deferring less urgent procedures. The decrease in donation and transplantation activity in the country has been dramatic. Between 1 January and 12 March 2020, the mean number of actual deceased organ donors was 7.1 per day and the mean number of organ transplants from deceased donors was 15.1 per day. Since a national state of alarm was declared by the government on 13 March 2020 until 3 April 2020, corresponding figures are 1.4 and 2.3, respectively.4 All live donation procedures have been postponed.

The Spanish system has initiated a centralized data collection to build evidence on the outcome of COVID-19 in transplanted patients.

REFERENCES

1. Ministerio de Sanidad, Secretaría General de Sanidad, Dirección General de Salud Pública, Calidad e Innovación, Centro de Coordinación de Alertas y Emergencias Sanitarias. Actualización nº 67 (6 de abril de 2020). Enfermedad por el coronavirus (COVID-19) (datos consolidados a las 21:00 horas del 05.04.2020). Available at: https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov-China/documentos/Actualizacion_67_COVID-19.pdf. Last access: 6 April 2020. 
2. Novel coronavirus disease 2019 (COVID-19) pandemic: increased transmission in the EU/EEA and the UK – sixth update. Available at: https://www.ecdc.europa.eu/sites/default/files/documents/RRA-sixth-update-Outbreak-of-novel-coronavirus-disease-2019-COVID-19.pdf. Last access: 6 April 2020. 
3. Spanish recommendations on donation and transplantation of organs in the COVID-19 pandemic. Available at: http://www.ont.es/infesp/Paginas/Recomen_prof.aspx. Last access: 6 April 2020.    
4. Impact of the COVID-19 pandemic on organ donation and transplantation activities in Spain. Available at: http://www.ont.es/infesp/Paginas/Impacto_tx.aspx. Last access: 6 April 2020.