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ALERT UP-DATE: Coronavirus (COVID-2019) and Ocular Tissue Donation.

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COVID-19 is an illness characterised by respiratory symptoms, including coughing, breathlessness, and fever. It is caused by infection of the newly identified Coronavirus, SARS-CoV-2. Its full pathogenesis remains unknown but individuals with certain underlying chronic conditions, the elderly, and immunocompromised individuals are at greater risk.

There is no evidence at present that coronaviruses can be transmitted by tissue or cell transplantation and therefore measures in this response are precautionary.

Response plans vary across the world, and will continue to change, depending on the country and the spread of the disease. Therefore, GAEBA advises all Eye Banks and their Medical Directors contact their jurisdictional permanent health authority and/or Eye Bank Association, to ascertain up-to-date local/regional exclusion and deferral criteria.

About COVID-2019 and ocular tissue donation

  1. The risk to the eye donor pool is considered low.
  2. COVID-19 is an illness characterised by respiratory symptoms, including coughing, breathlessness, and fever. Respiratory infection may become severe and can result in fatalities.
  3. The virus appears to be spread via respiratory droplets. It could also be spread when people touch an object which hosts the virus, and then touch their mouths, noses or eyes.
  4. There is no evidence at present that coronaviruses can be transmitted by blood transfusion or tissue or cell transplantation and therefore these measures are precautionary.

Of note: The virus is also present in tears and mucus membranes, so is a potential threat to those undertaking recovery of donated ocular tissue. Recommendations from the Royal College of Pathologists (UK) for care of deceased during COVID-19 pandemic include usual wearing of gowns, gloves, face masks and now include eye protection.

Many countries and regions are limiting or deferring elective surgeries during the pandemic period. This will decrease demand for transplant eligible donations, for many eye banks. Therefore, eye banks should consider current and future demand for tissue when planning for recoveries. Those who reduce services need to consider access to emergency tissue during this period.

Guidelines for Selection/Exclusion of Ocular Tissue Donors

Definitions

Confirmed Infection: If a diagnostic test has been performed and is positive, this constitutes a confirmed infection.

Suspected Infection: As per compatible symptoms of fever and flu-like symptoms such as coughing, sore throat and fatigue, and shortness of breath, and who has not been tested or is awaiting a test result.

Recovery from Coronavirus symptoms: In line with public health advice, donors can be considered to have recovered if they were free of fever and respiratory symptoms at the time of death. Some individuals may have had a persistent cough for some weeks after resolution of their infection.

Recommended Guidelines

1. Person with confirmed or suspected Coronavirus infection (including healthcare workers)

Must not donate if:

(a) Less than 14 days since resolution of symptoms due to confirmed coronavirus infection

(b) Awaiting test results for suspected coronavirus infection

Discretionary acceptance:

(a) Confirmed infection. If more than 14 days have passed since resolution of symptoms.

(b) Respiratory failure not related to viral infection, or where COVID-19 was ruled out following testing.

2. Contact with a confirmed or suspected case of Coronavirus infection

Must not donate if:

Less than 14 days from the first day of contact with an individual with a confirmed or suspected infection.

Discretionary acceptance:

(a) If more than 14 days since the first day of contact with an individual with a confirmed or suspected infection, and the donor remained well with no symptoms of Coronavirus infection.

(b) If less than 14 days and the donor remained well, with no symptoms of Coronavirus infection – subject to individual risk assessment.

(c) Donors without respiratory symptoms who are not suspected to have, and have not been tested for COVID-19 infection, and who were in intensive care units with patients who had been tested for COVID-19 infection and subsequently moved to isolation facilities following confirmation of infection – subject to individual risk assessment.

 

Resources

American Ophthalmology Society. Member Alert. https://mcusercontent.com/0412f950aa96d1122aaf84b86/files/23643b56-fcdf-41ec-a7b2-512182045453/AAO_Member_Alert_29_January_2020.pdf

Australian Government Department of Health. What you need to know about coronavirus (COVID-19). https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/what-you-need-to-know-about-coronavirus-covid-19#symptoms

Eye Bank Association of America. Information Alert: 2019 Novel Coronavirus (COVID-2019) and Eye issue Donation.

Centre for Disease Control (USA). 2019 Novel Coronavirus. https://www.cdc.gov/coronavirus/COVID-2019/index.html

Centre for Disease Control (USA). Interim Guidance for Healthcare Professionals. https://www.cdc.gov/coronavirus/COVID-2019/hcp/clinical-criteria.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2FCOVID-2019%2Fclinical-criteria.html

European Centre for Disease Prevention and Control (EU). Novel coronavirus in China  https://www.ecdc.europa.eu/en/novel-coronavirus-china

International Agency for the Prevention of Blindness. Eye care covid-19 Resource page

Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee. Geographical Disease Risk Index. https://protect-au.mimecast.com/s/V8BMC3Q8MvCrQnEjTqz7KF?domain=transfusionguidelines.org

Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee. JPAC Position Statement novel coronavirus (COVID-2019) – January 2020 https://www.transfusionguidelines.org/document-library/position-statements

New England Journal of Medicine. Transmission of COVID-2019 Infection from an Asymptomatic Contact in Germanyhttps://www.nejm.org/doi/full/10.1056/NEJMc2001468

Royal College of Pathologists Transmission-based precautions: Guidance for care of deceased during COVID-19 pandemic. March 19 2020 access document

The Lancet. COVID-2019 Resource Centre. https://www.thelancet.com/coronavirus

The Transplantation Society – Guidance on Coronavirus Disease 2019 (COVID-19) for Transplant Clinicians. https://tts.org/23-tid/tid-news/657-tid-update-and-guidance-on-2019-novel-coronavirus-2019-ncov-for-transplant-id-clinicians

World Health Organization. Global Surveillance for human infection with novel coronavirus (COVID-2019). https://www.who.int/publications-detail/global-surveillance-for-human-infection-with-novel-coronavirus-(COVID-2019)

Regional Eye Bank Association Resource Pages

 

For further information, please contact Heather Machin, at the Global Alliance via:  heather.machin@unimelb.edu.au