Guidelines for Liver Transplantation During the COVID Pandemic in the Philippines: Joint Statement of the Philippine Association of Hepato-Pancreato-Biliary Surgeons (PAHPBS) and the Hepatology Society of the Philippines (HSP), 08 December 2020
Author(s): Joint Liver Transplant Committee: Maria Vanessa H. De Villa, MD, PhD, Co-chair, Mara Teresa T. Panlilio, MD, Co-chair, Amornetta P. Jordan-Casupang, MD, Ian Homer Y. Cua, MD, Anthony Q. Yap, MD, Jade D. Jamias, MD, Marco M. Sumo, MD, Wendell Z. Espinosa, MD, Noruel Gerard A. Salvador, MD, Jennielyn C. Agcaoili-Conde, MD, Aldwin D. Ong, MD, MBA, Catherine SC Teh, MD, President 2020-20211 and Roberto N. De Guzman, Jr., MD, President 20202
The world is experiencing the worst health crisis in the 21st century thus far. After the Spanish flu pandemic of 1918, which claimed an estimated 50 million lives, this SARS-CoV-2 pandemic ravaging the world now may prove to be equally detrimental, if not worse. There have been tremendous consequences not only in the health sector but in all other arenas of life as well, with perhaps greater impact in developing countries like the Philippines. National statistics report that there have been more than 405,000 infected individuals from February until early November 2020. Fortunately, the local mortality rate is low at 2%1 , close to the current worldwide death toll of 2.4%.2 The country was first hit in the first quarter of the year 2020 and this necessitated a total lockdown of the National Capital Region (NCR) and nearby provinces. It then suffered a second wave sometime midyear which required continued community quarantine measures. The pandemic has shifted the focus of health care delivery to COVID cases and has affected organ donation and organ transplantation as well. Transplant-related activity stopped3,4 because priority had to be given to COVID patients and resources (ICU beds, personal protective equipment [PPEs], blood supply, pharmaceuticals, manpower) had to be channeled accordingly. Deceased donation was halted because of the challenges with SARS-CoV-2 PCR tests that could produce results in a few hours, as required in an emergency situation, and the uncertainties related to processing and procurement of organs from a deceased donor during a pandemic. The Philippine Network for Organ Sharing (PhilNOS) has remained silent throughout this health crisis. Nonetheless, patients will continue to get sick and suffer end-stage liver disease, whether it be acute or chronic illness, and therefore transplant activity must go on. Now about 9 months into the pandemic, health care providers have gained a better understanding of the pathogen and the disease it causes and therefore, have a better handle on the prevention of spread and management of the infected.5,6 With lessons learned, it is then about time to resume transplant activity7,8,9, keeping in mind always the safety of the patients, their families and health care workers in the quest to restore health in all those afflicted. The Philippine Association of Hepato-Pancreato-Biliary Surgeons (PAHPBS) and the Hepatology Society of the Philippines (HSP), the lead local professional societies dedicated to liver care, have then decided to partner in drawing guiding principles in the practice of liver transplantation during the COVID pandemic, which is far from over. The following recommendations are hereby put forth to guide the resumption of adult and pediatric liver transplant activity in the country in these crucial times.
Key words: Liver Transplantation During the COVID Pandemic