The COVID-19 outbreak in Italy: Initial implications for organ transplantation programs

Abstract

The spread of Coronavirus Disease 2019 (COVID-19) has already reached a pandemic dimension within a few weeks. Italy has been one of the first countries dealing with the outbreak of COVID-19, and severe measures have been adopted to limit viral transmission. The spread of COVID-19 may have several implications in organ transplant activity that physicians should be aware of. The initial experience gained during the COVID-19 outbreak shows that around 10% of infected patients in Italy need intensive care management to overcome the acute respiratory distress syndrome. Due to the exponential rise of infected patients we are now facing an actual risk of saturation of intensive care unit (ICU) beds. A restriction in the number of ICU beds available for both donors and transplant recipients may unfavorably influence the overall donation activity, and eventually lead to a reduced number of transplants. Preliminary Italian data show that a 25% reduction of procured organs has already occurred during the first 4 weeks of COVID-19 outbreak. This underlines the need to closely monitor what will be further happening in ICUs due to the COVID-19 spread in the attempt to preserve transplant activity, especially in Western countries where deceased donors represent the major organ resource.

Keywords: critical care/intensive care management; donors and donation: donor-derived infections; editorial/personal viewpoint; epidemiology; health services and outcomes research; infection and infectious agents - viral; infectious disease; organ procurement and allocation; organ procurement organization; organ transplantation in general.

FIGURE 1

Deceased donors used for organ transplantation during the initial Coronavirus Disease 2019 (COVID-19) outbreak, according to patients with COVID-19 admitted in intensive care unit in Italy. The figure describes the daily number of deceased donors used for organ transplantation from February 24, 2020 to March 22, 2020 (the first 4 wk of COVID-19 outbreak in Italy) compared with the daily average of deceased donors used during the same time frame of the last 5 y (2015-2019). The dotted line corresponds to the trend line of deceased donors since the COVID-19 spread in Italy. Data of patient with COVID-19 admitted in ICU were retrieved by the Italian National Institute of Health. *February 29, 2020 was a leap day, present only in 2016 and 2020. DD, deceased donor; ICU, intensive care unit; COVID-19, Coronavirus Disease 2019