OPTN/UNOS Guidance regarding Ebola Virus Disease (EVD)

[Clark]

http://transplantpro.org/guidance-regarding-ebola-virus-disease-evd/

Guidance regarding Ebola Virus Disease (EVD)

The OPTN/UNOS Ad Hoc Disease Transmission Advisory Committee (DTAC), after careful review of information available from the Centers for Disease Control (CDC), offers the following information to transplant centers and OPOs in light of the first case of Ebola virus disease (EVD) identified in the United States.  While the risk of a person with previously undiagnosed EVD becoming an organ donor is thought to be extraordinarily low, the risk of transmitting the disease through transplantation is unstudied.  Therefore, it is important for the transplant community to be aware of risk factors for this disease.
The CDC notes that early recognition is critical.  OPOs should consider the following points, as outlined by the CDC,  when evaluating potential organ donors:
Travel History
Has the donor been in a country where an Ebola outbreak occurred within the past 21 days?
Reported countries currently include:  Guinea, Liberia, Nigeria, Sierra Leone.  For up-to-date details on the affected areas of these countries, please visit the CDC’s West Africa EVD outbreak webpage.
A travel-associated case has been reported involving Dakar, Senegal.  For updated information, please visit the CDC’s West Africa EVD outbreak webpage.
Clinical Criteria
Does the donor have risk factors and consistent symptoms of the following?
Fever greater than 38.6 degrees Celsius/101.5 degrees Fahrenheit
Severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage; AND epidemiologic factors as described below.
Epidemiologic Risk Factors
Has the donor had any of the following:
Contact with blood, other body fluids, or human remains of a patient known or suspected to have Ebola?
Residence in OR travel to an area where Ebola transmission is active (see above) in the past 21 days?
Direct handling of bats or non-human primates from disease-endemic areas?
OPOs should focus on recent travel history and highlight this information when communicating with transplant hospitals considering organ offers.  Since the incubation period of Ebola virus disease is as long as 21 days, a returning traveler may theoretically harbor Ebola virus infection but not yet be symptomatic. If this person becomes a potential donor, transmission of Ebola virus to the recipient is possible.  If a potential organ donor is noted as having travel history and compatible symptoms, the DTAC suggests aborting the evaluation process and ruling out transplantation.
Additionally, if the potential donor was exposed to a sick individual with risk factors as listed above, OPOs should communicate this information to transplant hospitals considering organ offers.
If the need for future updates arise, they will be posted to the newsroom section of the OPTN and UNOS websites.  Please refer to the CDC’s website for updates and new developments regarding 2014 West Africa Outbreak.