COVID-19 Procedure: Lung Transplantation Pre-Transplantation Assessment:

COVID-19 Procedure: Lung Transplantation Pre-Transplantation Assessment

This process template is part of our COVID-19 Procedures pack. 

It is built as a reproduction of the procedures outlined in the Handbook of COVID-19 Prevention and Treatment (2020) produced by The First Affiliated Hospital, Zhejiang University School of Medicine (FAHZU). 

FAHZU had great success in combatting the novel Coronavirus COVID-19 and this handbook outlines best-practices, procedures, and useful charts for hospitals and medical centers to practically employ. 

The items contained within the handbook were compiled according to clinical experience. 

You can edit this process template to adapt it to the specific needs of your institution. When you come to follow the procedure, you can run this template as a checklist. You can add form fields throughout the checklist to gather information. You can connect your Process Street account with other platforms via automation to automatically store or utilize any data entered into your checklists. 

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You can find the full handbook embedded below.

Process Street is not a medical institution and the items contained in this process template are illustrative and not intended to be understood as medical advice. Please refer to the attached PDF document for any and all medical or operational recommendations. 

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Check the patient's age

It is recommended that the recipients are not older than 70. Patients over 70 years old are subject to careful evaluation of other organ functions and postoperative recovery capability.

Check the course of the disease

There is no direct correlation between the length of the disease course and the severity of the disease. However, for patients with short disease courses (fewer than 4-6 weeks), a full medical assessment is recommended to evaluate whether adequate medication, ventilator assistance, and ECMO support have been provided.

Check lung function status

Based on the parameters collected from lung CT, ventilator, and ECMO, it is necessary to evaluate whether there is any chance of recovery.

Perform a functional assessment of other major organs

  • 1
    Evaluation of the consciousness status of patients in critical condition using brain CT scan and electroencephalography is crucial, as most of them would have been sedated for an extended period;
  • 2
    Cardiac assessments, including electrocardiogram and echocardiography that focus on right heart size, pulmonary artery pressure and left heart function, are highly recommended;
  • 3
    The levels of serum creatinine and bilirubin should also be monitored; for patients with liver failure and renal failure, they should not be subjected to lung transplantation until the functions of the liver and kidney are recovered

Perform the nucleic acid test of COVID-19

The patient should be tested negative for at least two consecutive nucleic acid tests with a time interval longer than 24 hours. Given the increased incidents of COVID-19 test result returning from negative to positive after treatment, it is recommended to revise the standard to three consecutive negative results. Ideally, negative results should be observed in all body fluid samples, including blood, sputum, nasopharynx, broncho-alveolar lavage, urine, and feces. Considering the difficulty in operation, however, at least the testing of sputum and broncho-alveolar lavage samples should be negative.

Perform an assessment of infection status

With the extended in-patient treatment, some COVID-19 patients may have multiple bacterial infections, and thus a full medical assessment is recommended to evaluate the situation of infection control, especially for multidrug-resistant bacterial infection. Moreover, post-procedure antibacterial treatment plans should be formed to estimate the risk of post-procedure infections.

Undertake the preoperative medical assessment process

The preoperative medical assessment process for lung transplantation in COVID-19
patients is:

  • a treatment plan proposed by the ICU team
  • multidisciplinary discussion 
  • comprehensive medical evaluation
  • analysis and treatment of relative contraindications
  • pre-habilitation before lung transplantation.

Contraindications

Please refer to The 2014 ISHLT Consensus: A consensus document for the selection of lung transplantation candidates issued by the International Society for Heart and Lung Transplantation (updated in 2014).

Do you recommend the transplant?

Approval: Authorize the transplant

Will be submitted for approval:
  • Do you recommend the transplant?
    Will be submitted

Sources:

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