This page provides guidance to the transplant sector on the ongoing “COVID-normal” arrangements currently in place. As the situation continues to evolve, this information may change and will be updated.
- It is required that all international collections are cryopreserved at source and patient conditioning does not commence until cells are safely received and the post-thaw viability is confirmed.
- It is strongly recommended that PBSC be requested over bone marrow for international/interstate donors, where possible. Operating theatre capacity for bone marrow collections has been problematic in a number of countries; and flight impacts make fresh deliveries impossible for international donors and difficult for interstate donors.
- It is strongly recommended transplant centre staff are available to receive products outside of business hours / at short notice. While cryopreserved cell delivery is generally arranged for business hours, due to potential pickup/flight/customs delays this cannot be guaranteed.
- Each imported donation should be considered irreplaceable. In the current circumstances, it is not assured that any cells collected overseas for a patient can be replaced, or that subsequent donations can occur. Poor transport connections and reduced capacity issues are reducing the flexibility to manage unexpected collection issues; transplant centres will need to be mindful that the options to manage such eventualities may be limited.
- All verification and day-of-collection testing is to occur in the donor’s country of origin wherever feasible. The US continues to mandate the use of buccal swabs instead of blood for HLA verification; as do other countries as circumstances require. The following lists the standard ‘day of collection’ test requests which will be made for international apheresis collections:
- ABO group and antibody screen
- Red blood cell phenotype
- CD34 enumeration
- CD3 enumeration
- Microbial testing
- Routine pre-donation COVID testing of donors should be based on clinical need. Such testing is not mandatory or recommended if not clinically indicated. Where a clinical need has been identified, such testing is not to take place in public COVID testing clinics.
- ABMDR and international registries have implemented COVID-19 and health screening and risk assessment processes for all donors. These processes, that identify risk factors prior to verification testing and workup, will continue into the long term.
- All donors who report contact with a confirmed case will be deferred for 4 weeks following the date of last contact; donors with a history of COVID-19 infection will be deferred for at least 28 days after recovery. If the patient’s need for transplant is urgent, the donor is completely well and there are no suitable alternative donors, earlier collection may be considered if local requirements permit, subject to careful risk assessment.
- Following satisfactory completion of the Health & Availability Check during donor selection, Australian donors are permitted to undergo blood draws for HLA verification and infectious disease testing purposes prior to donor workup.
- Where a donor has incomplete recruitment data but, in the judgement of the search coordinator, is likely to be suitable for the requesting patient, the donor can proceed to the Health & Availability Check and then to the verification blood draw. ABMDR will monitor the utilisation of these donors.
- Australian donors should be supported to self-isolate prior to collection. It is acknowledged that some donors will be unable to self-isolate due to work and family commitments. However, a discussion with the donor on their support requirements – e.g. medical certificates – is encouraged.
- The time between workup and G-CSF/collection is to be minimised for Australian donors where practicable. This will mitigate any risk of the donor being exposed to COVID-19 between workup and collection, and involves:
- donors being “provisionally” cleared at the workup appointment (where appropriate) on the basis of the examination;
- workup blood testing and any COVID-19 testing (conducted during the workup appointment) is to be prioritised to return results on the same or next day where feasible;
- arrangements being made for the donor to commence G-CSF upon receiving the bulk of the test results – with self-administration of G-CSF to be encouraged; and
- any blood tests that take longer are to be considered “pending” where they are not expected to affect donor safety. The risk that a “pending” test like haemoglobinopathy screening could unexpectedly return an abnormal result may be, on balance, acceptable to a transplant centre.
The following existing arrangements remain unchanged.
Donor safety remains our priority.
In the current context, safety includes minimising donors’ potential exposure to COVID risks, by minimising their face-to-face interactions, maintaining social distancing and supporting their self-isolation prior to collection (where possible).
Donor travel is to be minimised.
Donors will not be requested to attend blood draws for extended typing purposes. Extended typing is being undertaken prior to the Health & Availability Check using stored samples for low-resolution typed Australian donors that appear in a search report for an Australian patient, and to complete missing donor enrolment data (e.g. blood type and CMV results). Where a stored sample is not available, ABMDR’s COVID Response Centre can arrange for donors to provided with swabs.
ABMDR has some arrangements in place to support the transport of fresh cells within Australia. For those wishing to arrange their own transport, several states have their own border requirements. Couriers must check local requirements before travel to NSW QLD WA TAS SA.