COVID-19 in Spain: Transplantation in the midst of the pandemic

Abstract

Spain has been one of the most affected countries by the COVID-19 outbreak. As of April 28, 2020, the number of confirmed cases is 210 773, including 102 548 patients recovered, more than 10 300 admitted to the ICU, and 23 822 deaths, with a global case fatality rate of 11.3%. From the perspective of donation and transplantation, the Spanish system first focused on safety issues, providing recommendations for donor evaluation and testing, and to rule out SARS-CoV-2 infection in potential recipients prior to transplantation. Since the country entered into an epidemiological scenario of sustained community transmission and saturation of intensive care, developing donation and transplantation procedures has become highly complex. Since the national state of alarm was declared in Spain on March 13, 2020, the mean number of donors has declined from 7.2 to 1.2 per day, and the mean number of transplants from 16.1 to 2.1 per day. Increased mortality on the waiting list may become a collateral damage of this terrible pandemic.

Keywords: clinical research/practice; donors and donation; donors and donation: donor evaluation; donors and donation: donor-derived infections; health services and outcomes research; infection and infectious agents - viral; infectious disease; organ procurement and allocation; organ transplantation in general.

FIGURE 1

Summary of Spanish recommendations for the evaluation and testing of deceased organ donors with regards to SARS-CoV-2. *Donation will be considered on a case-by-case basis in cured cases of COVID-19 after a minimum of 21 d following resolution of symptoms and completion of therapy. A cured case is defined as follows: Patient with confirmed COVID-19 (or highly suspicious) who was hospitalized: 21 d after the complete resolution of symptoms AND two negative SARS-CoV-2 RT-PCR in respiratory tract samples obtained >24 h apart. Patient with confirmed COVID-19 who was isolated at home: 21 d after the complete resolution of symptoms AND 2 negative SARS-CoV-2 RT-PCR in respiratory tract samples obtained >24 h apart. Patient with probable COVID-19 (ie, with no microbiological confirmation), who was isolated at home with suggestive symptoms and/or exposure to a confirmed case of COVID-19: if symptoms continue, donation will not proceed; if contact has occurred within the previous 21 d, screening for SARS-CoV-2 will be performed; if contact has occurred beyond the previous 21 d, donation will be considered as for any other potential donor [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 2

Number of actual deceased organ donors (A) and number of transplant procedures from deceased and live organ donors (B) at 7-d intervals. Spain 2020 [Color figure can be viewed at wileyonlinelibrary.com]