NOTTO guidelines for vaccine-induced thrombotic thrombocytopenia in organ donation and transplantation

Vivek B Kute; Sonal Asthana; Subhash Gupta; Sanjay K Agarwal; Swarnalatha Guditi; Manisha Sahay; Sujoy Pal; S Sudhindran; Ashish Sharma; Sandeep Seth; Alla Gopala Krishna Gokhale; Milind Dhahir Hote; Arpita Ray Chaudhury; Arvinder Singh Soin; Mohamed Rela; Rajesh Malhotra; Virinder K Bansal; Devinder Singh Rana; Rajneesh Sahai; Vasanthi Ramesh

doi:10.4103/ijot.ijot_135_21

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Year : 2022 \| Volume : 16 \| Issue : 1 \| Page : 3-7

NOTTO guidelines for vaccine-induced thrombotic thrombocytopenia in organ donation and transplantation Vivek B Kute¹, Sonal Asthana², Subhash Gupta³, Sanjay K Agarwal⁴, Swarnalatha Guditi⁵, Manisha Sahay⁶, Sujoy Pal⁷, S Sudhindran⁸, Ashish Sharma⁹, Sandeep Seth¹⁰, Alla Gopala Krishna Gokhale¹¹, Milind Dhahir Hote¹², Arpita Ray Chaudhury¹³, Arvinder Singh Soin¹⁴, Mohamed Rela¹⁵, Rajesh Malhotra¹⁶, Virinder K Bansal¹⁷, Devinder Singh Rana¹⁸, Rajneesh Sahai¹⁹, Vasanthi Ramesh¹⁹ ¹ Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India ² Department of Hepato Pancreato Biliary and Multi-organ Transplant, Aster Medicity Hospital, Bengaluru, Karnataka, India ³ Department of Gastrointestinal Surgery and Liver transplantation, Max Hospital, All India Institute of Medical Sciences, New Delhi, India ⁴ Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India ⁵ Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India ⁶ Department of Nephrology, Osmania Medical College, Hyderabad, Telangana, India ⁷ Department of Gastrointestinal, All India Institute of Medical Sciences, New Delhi, India ⁸ Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences, Kochi, Kerala, India ⁹ Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India ¹⁰ Department of Cardiology Surgery, and Liver transplantation, All India Institute of Medical Sciences, New Delhi, India ¹¹ Department of Cardiothoracic and Vascular Surgery, Apollo Hospitals, Jubilee Hills, Hyderabad, Telangana, India ¹² Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India ¹³ Department of Nephrology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India ¹⁴ Department of Liver Transplant Surgery, Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta, The Medicity, Gurugram, India ¹⁵ Dr. Rela Institute and Medical Centre, The Institute of Liver Disease and Transplantation, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India ¹⁶ Department of Orthopaedics, Trauma Centre, All India Institute of Medical Sciences, New Delhi, India ¹⁷ Department of Surgery, All India Institute of Medical Sciences, New Delhi, India ¹⁸ Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India ¹⁹ National Organ and Tissue Transplant Organisation, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India Correspondence Address: Vasanthi Ramesh National Organ and Tissue Transplant Organisation, Vardhman Mahavir Medical College and Safdarjung Hospital, A-7-3, M.S. Flats, Sector 13, R.K. Puram, New Delhi - 110 066 India Source of Support: None, Conflict of Interest: None DOI: 10.4103/ijot.ijot_135_21

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 risk‒benefit 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.



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