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Indian Journal of Transplantation ; 16(1):3-7, 2022.
Article in English | EMBASE | ID: covidwho-1798826

ABSTRACT

From the context of organ donation, COVID-19 vaccine-induced thrombotic thrombocytopenia (VITT) is important as there is an ethical dilemma in utilizing versus discarding organs from potential donors succumbing to VITT. This consensus statement is an attempt by the National Organ and Tissue Transplant Organization (NOTTO) apex technical committees, India, to formulate the guidelines for deceased organ donation and transplantation in relation to VITT to help in appropriate decision-making. VITT is a rare entity, but a meticulous approach should be taken by the organ procurement organization's (OPO) team in screening such cases. All such cases must be strictly notified to the national authorities (NOTTO) as a resource for data collection and ensuring compliance with protocols in the management of adverse events following immunization. Organs from any patient who developed thrombotic events up to 4 weeks after adenoviral vector-based vaccination should be considered to be linked to VITT and investigated appropriately. The viability of the organs must be thoroughly checked by the OPO, and the final decision in relation to organ use should be decided by the expert committee of the OPO team consisting of a virologist, a hematologist, and a treating team. Considering the organ shortage, in case of suspected/confirmed VITT, both clinicians and patients should consider the riskbenefit equation based on limited experience. An appropriate written informed consent of potential recipients and family members should be obtained before the transplantation of organs from suspected or proven VITT donors.

2.
ASAIO Journal ; 67(SUPPL 3):38, 2021.
Article in English | EMBASE | ID: covidwho-1481580

ABSTRACT

Severe acute respiratory distress syndrome (ARDS) due to COVID-19 continues to be a common cause of morbidity and mortality. Early reports showed a potential therapeutic benefit of extracorporeal membrane oxygenation (ECMO) for these patients. Our IRB-approved, retrospective study examined seven children with COVID 19 (0-18 years of age) placed on ECMO from March 2020 to April 2021. Three of the patients were on veno-venous ECMO;four on veno-arterial ECMO. While on ECMO, 5 of the 7 patients had hemorrhage, and 3 had thrombotic complications. The mortality rate was 28%. The median times from onset of symptoms to ECMO cannulation was 9 days, and from intubation to ECMO was 5 days. Five of the 7 patients received convalescent plasma and Remdesivir. We also identified seventeen non-cardiac, non-COVID ECMO patients as controls. The median ECMO duration for the COVID-19 (Cov) patients was 14 days. (controls: 8 days) The median maximum heparin dose for the Cov patients was 25 units/kg/hour. (controls: 24 units/kg/hr) The median maximum bivalirudin dose for the Cov group was 0.34 mg/kg/hr. (controls: 0.46 mg/kg/hr) The median blood product transfusions per ECMO day for the Cov group were: red cells (0.33;controls: 0.55);platelets (0.67;controls: 0.20);plasma (0.05;controls: 0.09) and cryoprecipitate (0.13;controls: 0). Other laboratory parameters examined were d dimer, red blood cells, white blood cells, platelets, and fibrinogen levels. There were clinical differences observed in anticoagulation and blood product usage between the COVID-19 and non COVID ECMO patients.

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