The rapid emergence of the COVID-19 pandemic is unprecedented and poses an unparalleled obstacle in the sixty-five year history of organ transplantation. Worldwide, the delivery of transplant care is severely challenged by matters concerning - but not limited to - organ procurement, risk of SARS-CoV-2 transmission, screening strategies of donors and recipients, decisions to postpone or proceed with transplantation, the attributable risk of immunosuppression for COVID-19 and entrenched health care resources and capacity. The transplant community is faced with choosing a lesser of two evils: initiating immunosuppression and potentially accepting detrimental outcome when transplant recipients develop COVID-19 versus postponing transplantation and accepting associated waitlist mortality. Notably, prioritization of health care services for COVID-19 care raises concerns about allocation of resources to deliver care for transplant patients who might otherwise have excellent 1-year and 10-year survival rates. Children and young adults with end-stage organ disease in particular seem more disadvantaged by withholding transplantation because of capacity issues than from medical consequences of SARS-CoV-2. This report details the nationwide response of the Dutch transplant community to these issues and the immediate consequences for transplant activity. Worrisome, there was a significant decrease in organ donation numbers affecting all organ transplant services. In addition, there was a detrimental effect on transplantation numbers in children with end-organ failure. Ongoing efforts focus on mitigation of not only primary but also secondary harm of the pandemic and to find right definitions and momentum to restore the transplant programs.

COVID-19大流行的迅速出现是前所未有的，给器官移植65年的历史带来了前所未有的障碍。在世界范围内，移植护理的提供受到以下问题的严重挑战：但不限于器官获取、SARS-CoV-2 传播风险、捐赠者和接受者的筛选策略、推迟或继续移植的决定、可归因的风险针对 COVID-19 的免疫抑制以及根深蒂固的医疗保健资源和能力。移植界面临两害相权取其轻的问题：当移植受者出现 COVID-19 时启动免疫抑制并可能接受有害结果，而不是推迟移植并接受相关的等待名单死亡率。值得注意的是，将医疗保健服务优先用于 COVID-19 护理引起了人们对资源分配的担忧，以向移植患者提供护理，否则这些患者可能具有出色的 1 年和 10 年生存率。尤其是患有终末期器官疾病的儿童和年轻人，由于能力问题而不是 SARS-CoV-2 的医疗后果，似乎因拒绝移植而处于更不利的地位。本报告详细介绍了荷兰移植界在全国范围内对这些问题的反应以及移植活动的直接后果。令人担忧的是，器官捐献数量显着减少，影响了所有器官移植服务。此外，对终末器官衰竭儿童的移植数量也有不利影响。目前的工作重点是减轻大流行的主要伤害和继发伤害，并找到恢复移植计划的正确定义和动力。