key: cord-256218-xv7aw4xn authors: Vargas, Maria; Iacovazzo, Carmine; Servillo, Giuseppe title: Additional Suggestions for Organ Donation During COVID-19 Outbreak date: 2020-06-16 journal: Transplantation DOI: 10.1097/tp.0000000000003314 sha: doc_id: 256218 cord_uid: xv7aw4xn nan C OVID-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) . 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. Additional suggestions for organ donation during COVID-19 a Sudden isolation from other patients to minimize the risk of transmission from unknown COVID-19 cases COVID-19 testing on bronchoalveolar lavage and nasal cavity specimen Screening for 1.domicile, travel, or prolonged stay in the zones where COVID-19 cases were currently recognized 2.close contact with suspected or confirmed cases of COVID-19 3.close contact with patients with respiratory symptoms at risk of COVID-19 4.respiratory symptoms before the ICU admission Evaluation of the presence of possible COVID-19 respiratory like symptoms Performance of lung computed tomography to assess the presence of radiological patterns of COVID-19 Limit the access to the isolation room Permission to access only for healthcare personnel screened for no exposure to COVID-19 and without COVID-19 respiratory symptoms Allow the access only with personal protective equipment suggested for COVID-19 Organ procurement surgeons Coming from hospitals without COVID-19 cases Screening for: 1.domicile, travel, or prolonged stay in the zones where COVID-19 cases were currently recognized 2.close contact with suspected or confirmed cases of COVID-19 3.close contact with patients with respiratory symptoms at risk of COVID-19 Absence of possible COVID-19 respiratory symptoms In case of COVID-19 positive screening and respiratory symptoms → ask for a different surgical team Travel with dedicated military flights properly disinfected. Avoid the use of commercial flights Prepare a dedicated operating room Access to the operating room only with personal protective equipment suggested for COVID-19 COVID-19-situation in Italy Evidence-based guideline update: determining brain death in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology 22 AGOSTO 1994, n. 582 (G.U. del 19-10-1994 n.245) Regolamento recante le modalità per l'accertamento e la certificazione di morte How will countrybased mitigation measures influence the course of the COVID-19 epidemic?