Additional Suggestions for Organ Donation During COVID-19 Outbreak.

COVID-19 is dramatically increasing in Italy, the last report from the ministry of health on March 9 reported the presence of 9172 confirmed cases and 733 patients in intensive care unit (ICU).[1] On March 3, we admitted in our ICU a 65-year-old male patient with a diagnosis of Fisher IV—subarachnoid hemorrhage due to an arteriovenous malformation of the anterior communicating artery. Despite the attempt of arteriovenous malformation clipping and medical management including intubation, ventilation, mannitol, nimodipine, and close monitoring of blood pressure administrated in ICU, the patient met the criteria of brain death after 24 hours.[2] Suddenly we started the evaluation of brain death according to the Italian law,[3] and, since the patient’s family gave us the consent for organ donation, we informed the local and the national centers for organ recovery. At that time, our hospital had no cases of COVID-19. However, since the Italian and worldwide dramatic spread of this infection,[4] we pointed out additional suggestions (1) to evaluate the possible exposures and (2) to protect from potential exposures the organ donor (Table 1).

TABLE 1.

Additional suggestions for organ donation during COVID-19

According to our suggestions, the organ donor had no positive history for exposure and no symptoms of COVID-19. During the ICU stay, the organ donor did not develop any COVID-19 respiratory symptoms; we performed a lung CT scan that was negative and, finally, the nasopharyngeal test for COVID-19 returned negative before the organ transplantations. The organs recovered and successfully transplanted were the corneas, heart, liver, and kidneys.

Regarding the healthcare personnel, we limited the access to the organ donor allowing it exclusively to personnel with negative history of exposure, without respiratory symptoms, and properly equipped with personal protective equipment suggested for COVID-19. The same precautions were adopted for the surgical team responsible of the organ procurement.

According to the literature, this is the first case of organ donation after brain death during the COVID-19 outbreak. We hope that our suggestions may improve the safety of organ donor and the safety of transplantation during the worldwide spread of COVID-19 cases.