An International survey on living kidney donation and transplant practices during the COVID‐19 pandemic

Abstract

The scope of the impact of the Coronaviru s disease 19 (COVID‐19) pandemic on living donor kidney transplantation (LDKT) practices across the world is not well defined. We received survey responses from 204 transplant centers internationally from May to June 2020 regarding the impact of the COVID‐19 pandemic on LDKT practices. Respondents represented 16 countries on 5 continents. Overall, 75% of responding centers reported that LDKT surgery was on hold (from 67% of North American centers to 91% of European centers). The majority (59%) of centers reported that new donor evaluations were stopped (from 46% of North American centers to 86% of European centers), with additional 23% of centers reporting important decrease in evaluations. Only 10% of centers reported slight variations on their evaluations. For the centers that continued donor evaluations, 40% performed in‐person visits, 68% by video, and 42% by telephone. Center concerns for donor (82%) and recipient (76%) safety were the leading barriers to LDKT during the pandemic, followed by patients concerns (48%), and government restrictions (46%). European centers reported more barriers related to staff limitations while North and Latin American centers were more concerned with testing capacity and insufficient resources including protective equipment. As LDKT resumes, 96% of the programs intend to screen donor and recipient pairs for coronavirus infection, most of them with polymerase chain reaction testing of nasopharyngeal swab samples. The COVID‐19 pandemic has had broad impact on all aspects of LDKT practice. Ongoing research and consensus‐building are needed to guide safe reopening of LDKT programs.

Practicing With Uncertainty: Kidney Transplantation During the COVID-19 Pandemic

“…17 Recent surveys show wide variation in adoption of these recommendations. 6,7 In July 2020, the AST modified recommendations to suggest that while self-quarantine is recommended as a preventive strategy, it should not be mandatory. 16 Given the widespread nature of the pandemic, individuals who have recovered from COVID-19 may present for living donor candidate evaluation.…”

“… 4 Similar suspensions were reported globally. 5 , 6 The rationale for the dramatic early disruption of practices included the categorization of LDKT as “elective” (ie, distinct from some “essential” DDKT) and possible to safely delay, especially in locations with strained resources, including the availability of ventilators ( Fig 1 ). 7 In addition, LDKT has additional complexity related to safety concerns for recipients (given early reports suggesting that they faced substantially increased mortality risks following severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] infection) 8 , 9 and also for living donors.…”

“…15 , 16 , 17 These societies endorse proceeding with living donation for asymptomatic individuals with a negative nasopharyngeal swab nucleic acid test result close to the time of donation surgery, and surveys of living-donor programs suggest strong agreement with this recommendation. 6 , 7 However, the duration of predonation quarantine is more controversial. The American Society of Transplant Surgeons recommends a period of at least 7 days and preferably 2 weeks before donation for donors and recipients of LDKTs.…”

“…17 Recent surveys show wide variation in adoption of these recommendations. 6 , 7 In July 2020, the AST modified recommendations to remove the mandate for self-quarantine, but it was still recommended as a preventive strategy. 16…”

“…Surveys of US and international centers identified barriers to living donor follow-up during the pandemic. 6 , 7 The waiver was initially heavily used, with 40% of living donor follow-up in amnesty status by late June 2020, including as many as 60% of these forms in some regions. 26 However, as of December 2020, more than 70% of forms have been completed.…”