“Challenges for liver transplantation during recovery from the COVID-19 pandemic: insights and recommendations”

Niriella, M. A.; Siriwardana, R. C.; Perera, M.T.P.R.; Narasimhan, G.; Chan, S. C.; Dassanayake, A. S.

Abstract The coronavirus disease 2019 (COVID-19) pandemic is placing an increasing burden on liver transplant (LT) services worldwide. At the peak of the pandemic, many liver transplant (LT) services worldwide dropped down or halted their activities. With the gradual easing of lockdowns, LT teams face new challenges when restarting activities. The numbers of liver transplants are likely to drop in the immediate post-COVID era. Prolong, and intermittent lockdowns are likely to lead to a shortage of supplies, especially in poor resource settings. Special attention is needed to avoid nosocomial COVID-19 infection among cirrhotic patients awaiting transplant, post-transplant patients as well as members in transplant teams. LT programs may have to revise the existing strategies in selecting donors and recipients for transplants. Re-designing service provision, restructuring of outpatient care, careful screening and selection of donors and recipient, performing LT with limited resources will have to be initiated in the post-COVID era if long-term recovery of LT services are to be expected. Costs involved with LT are likely to increase, considering the change in protocols of testing, quarantining, and interstate traveling. This paper discusses the different elements affecting and the widespread impact of COVID-19 pandemic on LT and strategies to minimize the impact of these factors and to adapt so LT services can meet the healthcare needs during this pandemic and beyond.