key: cord-0767329-342z5w6h
authors: Hugo, C; Strassburg, C; Stecher, M; Rahmel, A
title: Stable and safe organ procurement and transplantation during SARS‐CoV‐2 pandemic in Germany
date: 2020-07-22
journal: Transpl Int
DOI: 10.1111/tri.13704
sha: 720a792039779ada05a24dbca34b4ab86832c23b
doc_id: 767329
cord_uid: 342z5w6h

Solid organ transplantation is a lifesaving routine procedure. In the wake of the COVID‐19 pandemic, procurement and transplantation programs in many countries experienced a considerable reduction of organ donation and transplantation by up to 90% caused by an capacity overload of health care providers but also for fear of increased COVID‐19 related risks for transplant recipients acquired by viral transmissions from donor to recipient or early after transplantation. Competition for intensive care capacity for severely ill COVID‐19 patients versus transplant recipients and organ donors could also have played a role. In Germany, early pandemic management with high capacity testing including all potential organ donors, marked extension of intensive care capacities, structural health care system with a relatively high number of hospitals with intensive care units (1248) as well as transplant centers (40) with high capacities and regional organization of organ donation and transplantation may have been advantageous.

https://orcid.org/0000-0001-5895-3005 christian.hugo@uniklinikum-dresden.de

The authors declare no funding or conflicts of interests.

Solid organ transplantation is a lifesaving routine procedure. In the wake of the COVID-19 pandemic, procurement and transplantation programs in many countries experienced a considerable reduction of organ donation and transplantation by up to 90% 1 caused by an capacity overload of health care providers but also for fear of increased COVID-19 related risks for transplant recipients acquired by viral transmissions from donor to recipient or early after transplantation 2 . Competition for intensive care capacity for severely ill COVID-19 patients versus transplant recipients and organ donors could also have played a role. In Germany, early pandemic management with high capacity testing including

This article is protected by copyright. All rights reserved all potential organ donors, marked extension of intensive care capacities, structural health care system with a relatively high number of hospitals with intensive care units (1248) as well as transplant centers (40) with high capacities and regional organization of organ donation and transplantation may have been advantageous. Here we present data demonstrating that despite having high SARS-CoV-2 infection rates per million inhabitants (approx. 2200 pmp, end of May), organ procurement and transplantation rates in Germany remained completely stable. Transplantation rates for any deceased donor organ remained stable during the pandemic. The inhomogeneous COVID-19 disease distribution within Germany ( Figure 1C ) was not reflected by regional changes in organ donation ( Figure 1D) . A survey demonstrated that all regional transplant programs continued their transplant activity for any deceased donor organs using a careful risk-benefit evaluation for each recipient. Based on the same consideration living donor transplants were generally paused.

Organ transplantation during pandemic appeared to be safe, since only few SARS-CoV-2-infected transplant recipients (55 up to end of May) were reported to the largest German COVID-19 registry (LEOSS). Of these patients, only 4 (7.3%) had developed COVID-19 disease within the first three months after transplantation. In addition, of the 743 potential donors (03 -05/2020) reported to the DSO only 5 (0.7%) had to be excluded from donation due to a positive SARS-CoV-2-PCR. To date, no donor to the recipient transmission of the infection has been reported in Germany.

This article is protected by copyright. All rights reserved

In conclusion, the favourable health care conditions and management in Germany allowed stable and safe organ procurement and transplantation despite more than 180,000 SARS-Cov-2 infections. The overall unfavorable organ donation situation leading to long organ waiting times may have contributed to the strategic decision to continue with all transplant program activities during the pandemic.

1A: Average daily number of actual organ donors and transplanted organs in Germany for each week from January to May 2020, versus cumulative number of SARS-CoV-2 positive patients. 

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