Page History

COVID-19 infection and risk exposure

• History of COVID-19 infection
• Contact with COVID-19 – donors who report contact with a confirmed case
• Donor preparation
• Donation collection
• Planned cryopreservation
• Post-donation cryo-quarantine
• Summary table

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History of COVID-19 infection

Collection should be deferred for at least 7 days after full recovery from acute symptoms. For example, a donor who has a minor, non-productive cough but no other symptoms for the last 7 days may be accepted.

For asymptomatic infections, defer for at least 7 days after the most recent first positive test result.

Most healthy young donors can be expected to recover within a week, so for scheduling purposes it would be reasonable to schedule (or reschedule) collection for 14 days following onset of symptoms or first positive test result.

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*There is ample evidence that SARS-CoV-2 RNA can remain detectable by PCR in nasopharyngeal samples for an extended period after full recovery, but without being infectious.  Nonetheless some institutions may still consider a donor with detectable nasopharyngeal SARS-CoV-2 RNA to be a public health risk.

Contact with COVID-19 – donors who report contact with a confirmed case

Collection should be deferred for 14 7 days after a donor’s last contact with a person with COVID-19 either confirmed or clinically suspected by a health professional.

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 public health requirements permit, subject to careful risk assessment.  For example, many local guidelines will permit an early end to self-isolation if an asymptomatic contact of a COVID-19 case tests negative at earlier than 7 days post-contact.

Risk assessment should be based on:

• The last date of contact.
• The nature of the contact.
• The results of any post-contact testing.

Geographical risk – donors residing in or returning from a high-incidence region

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In the absence of known contact with COVID-19, risk assessment should take into account:

• The level of risk in the region visited, including any variants of concern known to be circulating.
• Any contact with a person with known SARS-CoV-2 infection.
• The applicable public health restrictions in the donor’s region.

Donor preparation

For at least 14 days prior to donation, donors in a region with ongoing local transmission should be advised to practice good hygiene and to socially isolate as much as possible. Unnecessary travel should be avoided.

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However, it is acknowledged that many jurisdictions have recommended or even mandated routine pre-donation screening of HPC donors.  Depending on the stipulated purpose, any such testing should be performed early enough to forestall patient conditioning, donor mobilisation or collection.

Donation collection

In the absence of symptoms, testing the donor for COVID-19 at the point of collection – or testing the donation itself – is not recommended because:

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• The donor is a volunteer who in most cases has already started or completed G-CSF conditioning.
• There is a possibility of false positive results with rapid or instant screening assays.
• The blood phase of COVID-19 is known to be difficult to detect in symptomatic patients, rarely detectable in pre-symptomatic patients, and there is no evidence for its infective potential.
• Any delay in transplant that results from the cancellation or rejection of the donation will therefore disadvantage the patient with no known or likely risk of COVID-19 transmission.

Planned cryopreservation

If there is concern that the donor is at high risk of community-acquired infection between work-up and collection, pre-planned cryopreservation will allow patient conditioning to be delayed until successful donation and delivery are confirmed.

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Reassuringly, however, data published by the US National Marrow Donor Program (NMDP) showed no significant adverse effect on early transplant outcomes from cryopreserved product during the COVID-19 pandemic compared to the same months in 2019 [Stefanski et al, Blood (2021) 138 (Supplement 1): 478].

Post-donation cryo-quarantine

By delaying patient conditioning, cryopreservation will also delay product infusion for at least several days after donation.  This means it becomes possible for the transplant centre to be warned if the donor develops COVID-19 symptoms shortly after donating.

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Nonetheless, it is acknowledged that certain jurisdictions may require cryo-quarantine by regulation.

Summary table