key: cord-0047860-0aqiiu45 authors: Domínguez-Gil, Beatriz; Coll, Elisabeth; Ferrer-Fàbrega, Joana; Briceño, Javier; Ríos, Antonio title: Dramatic impact of the COVID-19 outbreak on donation and transplantation activities in Spain() date: 2020-07-19 journal: nan DOI: 10.1016/j.cireng.2020.07.007 sha: e784f22084a6e1bd29f0747787c6948cf3c7cb1e doc_id: 47860 cord_uid: 0aqiiu45 nan 1 Drástico impacto de la epidemia de COVID-19 sobre la actividad de donación y trasplante en España [ Although the potential for transmission of COVID-19 through transplantation is unknown, as early as January 2020 the Spanish healthcare system issued recommendations for the evaluation and selection of organ donors regarding SARS-CoV-22 infection. 2 Donation in confirmed COVID-19 cases must be ruled out. In cured patients, individualized and cautious evaluation is recommended, and this should be done a minimum of 21 days after testing negative. As for donors at epidemiological risk (exposure to a confirmed case of COVID-19 or travel/residence in affected areas in the previous 21 days), if the potential donor presents clinical symptoms compatible with COVID-19, donation is rejected even without screening. If the potential donor does not present compatible symptoms, screening for SARS-CoV-2 is performed and donation is not considered if the result is positive. Screening is also mandatory if there is no epidemiological risk but clinical symptoms are compatible, or if lung or intestinal donation is considered. Although the incubation period for COVID-19 is 2-14 days, the recommended safety period in Spain of 21 days is to rule out possible outliers. 2 Screening of potential donors must be done by RT-PCR on a sample obtained in the 24 hours prior to extraction. 2 Said sample can be obtained from the upper or lower respiratory tract, although the latter is preferable due to its greater diagnostic performance, and this sample is required in cases of lung or intestinal donation. There is little information on the prognostic factors and the evolutionary course of COVID-19 in transplant patients. Given how the endemic coronavirus infection behaves in immunosuppressed patients, 3 a higher complication rate is expected, 4-6 which has been confirmed in limited case series. 7 It is also predictable that the period of viral excretion is longer than in non-transplant recipients, with the risk of 'superspreading' the virus, particularly among healthcare professionals. 8, 9 For this reason, in Spain, screening for SARS-CoV-2 is recommended in the potential recipient prior to transplantation, and the patient is temporarily excluded from the waiting list if the result is positive. 2 The greatest problem caused by the COVID-19 epidemic in organ donation and transplantation has been the consequent saturation of the healthcare system and intensive care units. Hospitals have had to expand the capacity of their critical care units, new hospitals have been created to serve seriously ill patients with COVID-19, and hotels have been medicalized to care for non-seriously ill patients requiring isolation. Despite this, medical professionals have had to make complex decisions when allocating critical resources that were insufficient for the population demand during the exponential increase in the number of infections. 10 In this context, conducting organ donation and transplantation activities has been extraordinarily complex due to the saturated system and the lack of COVID-19-free areas in hospitals in order to guarantee patient safety after transplantation. Hospitals in highly affected areas have been instructed to make individualized assessments, case by case, of whether to proceed with each donation and transplant process, taking into account the patient's clinical situation and the circumstances of the hospital. 2 In the worst moments, only ideal donors were considered, and transplantation was only performed in patients in emergency situations or those presenting extreme clinical severity, or those who were difficult to transplant. All this has led to a drastic decrease in activity. On March 13, 2020, the national 'State of Alarm' status was declared in Spain. Until that date, the mean transplant activity in our country was maintained at 7.2 donors/day and 16.1 transplants/day. After that point, the numbers dropped to 1.1 and 2, respectively (Figures 1 and 2) . Although it is early to evaluate the impact of this reduced transplant activity, it is presumable that, under normal circumstances, the deaths of patients who were on the waiting list could have been avoidedpatients who were also direct victims of this terrible pandemic. This study has received no specific funding coming from public, commercial or nonprofit organisms. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China Recomendaciones para la donación y el trasplante en relación con la epidemia de COVID-19 A prospective hospitalbased study of the clinical impact of non-severe acute respiratory syndrome (Non-SARS)-related human coronavirus infection Coronavirus Disease 2019: Implications of Emerging Infections for Transplantation Severe Acute Respiratory Syndrome (SARS) in a liver transplant recipient and guidelines for donor SARS screening MERS CoV infection in two renal transplant recipients: case report COVID-19 in solid organ transplant recipients: a single-center case series from Spain Prolonged shedding of human coronavirus in hematopoietic cell transplant recipients: risk factors and viral genome evolution Atypical presentations of MERS-CoV infection in immunocompromised hosts Recomendaciones éticas para la toma de decisiones en la situación excepcional de crisis por pandemia COVID-19 en las unidades de cuidados intensivos We would like to acknowledge medical professionals for their tireless work during the COVID-19 epidemic.