The rapid emergence of the COVID-19 pandemic is unprecedented and poses an unparalleled obstacle in the sixty-five year history of organ transplantation. Worldwide, the delivery of transplant care is severely challenged by matters concerning - but not limited to - organ procurement, risk of SARS-CoV-2 transmission, screening strategies of donors and recipients, decisions to postpone or proceed with transplantation, the attributable risk of immunosuppression for COVID-19 and entrenched health care resources and capacity. The transplant community is faced with choosing a lesser of two evils: initiating immunosuppression and potentially accepting detrimental outcome when transplant recipients develop COVID-19 versus postponing transplantation and accepting associated waitlist mortality. Notably, prioritization of health care services for COVID-19 care raises concerns about allocation of resources to deliver care for transplant patients who might otherwise have excellent 1-year and 10-year survival rates. Children and young adults with end-stage organ disease in particular seem more disadvantaged by withholding transplantation because of capacity issues than from medical consequences of SARS-CoV-2. This report details the nationwide response of the Dutch transplant community to these issues and the immediate consequences for transplant activity. Worrisome, there was a significant decrease in organ donation numbers affecting all organ transplant services. In addition, there was a detrimental effect on transplantation numbers in children with end-organ failure. Ongoing efforts focus on mitigation of not only primary but also secondary harm of the pandemic and to find right definitions and momentum to restore the transplant programs.

Worldwide collaboration will be required to define viral pathogenesis, correlates of immunity, and biomarkers for progressive infection to optimize clinical care and to interrupt pandemic spread of SARS-CoV-2.

This month’s installment of “The AJT Report” explores the role of the transplant community in the wider healthcare framework as both entities navigate the challenges of COVID-19. We also report on the Centers for Medicare & Medicaid Services’ recently proposed updates to the Organ Procurement Organization Conditions for Coverage.

A novel coronavirus, SARS-CoV-2, causing a severe acute respiratory syndrome with its disease designated as COVID-19, emerged from its epicenter in Wuhan China in December 2019 and is now a global pandemic. As of March 11th 2020, COVID -19 has been confirmed in 114 countries, involves 118,381 cases globally with 4292 deaths.1 The majority of reported infections are in China followed by Italy, iran, Republic of Korea and the European Union.1 Italy has gone into lockdown as a country on March 9, 2020, while in other countries such as the United States of America, several states have declared emergencies, focal biocontainment territories have been placed on lockdown and cases are been reported to increase at an alarming rate.