Minor surgery

Condition

Any surgical procedure that does not involve general anesthesia or respiratory assistance e. g. nevus excision, dental surgery, skin biopsies, minor injuries / cuts

Individual at risk

Donor / recipient

Guidance at RECRUITMENT for adult volunteer donor and maternal donor (cord blood donation)

ACCEPTABLE (unless the underlying condition requires deferral)

Guidance at CT/WORK-UP

Clinical reasoning by physician should be used; donors should be eligible, but may be made temporarily unavailable for 3 - 4 weeks after surgery.

Inform requesting transplant centre and advise of the risk of transmissible diseases, especially if surgery has occurred as a result of injury.

Ensure infectious disease markers are repeated 3 – 4 weeks following surgery.

Justification for guidance

Healing progression and risk for infections (local wound infections as well as systemic infections like hepatitis or tetanus) can only be assessed AFTER a reasonable time lag.

Major surgery

Condition

Any surgical procedure that involves general anesthesia or respiratory assistance

Individual at risk

Donor / recipient

Guidance at RECRUITMENT for adult volunteer donor and maternal donor (cord blood donation)

ACCEPTABLE

Guidance at CT/WORK-UP

TEMPORARILY UNAVAILABLE for 4 months

If the surgical procedure was less than 4 months ago this time period may be shortened at the discretion of the assessing physician.

Inform requesting transplant centre and proceed with CT only if requested.

Justification for guidance

Healing progression and risk for infections (local wound infections as well as systemic infections like hepatitis or tetanus) can only be assessed AFTER a reasonable time lag.

Endoscopy

Condition

Any procedure involving examination of the gastro-intestinal or genito-urinary tract with a rigid or flexible endoscope. However, the guidelines are particularly appropriate to endoscopy or catheterization with flexible, non-single use equipment.

Individual at risk

Recipient

Guidance at RECRUITMENT for adult volunteer donor and maternal donor (cord blood donation)

ACCEPTABLE

Guidance at CT/WORK-UP

Temporary deferral for 4 months due to potential transmission of infectious diseases.

The transplant centre should be informed and this time period may be shortened at their discretion.

Justification for guidance

Healing progression and risk for infections (local wound infections as well as systemic infections like hepatitis or tetanus) can only be assessed AFTER a reasonable time lag.

References

Investigation of viral hepatitis infections possibly associated with health-care delivery--New York City, 2008-2011. MMWR Morb Mortal Wkly Rep 2012; 61(19): 333-8.

Wu H, Shen B. Health care-associated transmission of hepatitis B and C viruses in endoscopy units. Clin Liver Dis 2010; 14(1): 61-8; viii.

Gutelius B, Perz JF, Parker MM, Hallack R, Stricof R, Clement EJ et al. Multiple clusters of hepatitis virus infections associated with anesthesia for outpatient endoscopy procedures. Gastroenterology 2010; 139(1): 163-70.

Gonzalez-Candelas F, Guiral S, Carbo R, Valero A, Vanaclocha H, Gonzalez F et al. Patient-to-patient transmission of hepatitis C virus (HCV) during colonoscopy diagnosis. Virol J 2010; 7: 217.

Toda T, Mitsui T, Tsukamoto Y, Ebara T, Masuko K, Takahashi M et al. No evidence for patient-to-patient transmission of hepatitis C virus during upper gastrointestinal endoscopy: molecular studies on three acute hepatitis C patients. Dig Endosc 2009; 21(3): 147-53.

Dore GJ, Haber PS. Tell me it ain't so: patient-to-patient transmission of hepatitis C in an endoscopy clinic. Hepatology 2008; 48(4): 1333-5.

Boustiere C, Napoleon B, Delasalle P, Coulom P. Digestive endoscopies are not a risk factor for transmission of virus C. J Viral Hepat 2008; 15(2): 155.

Nelson DB. Hepatitis C virus cross-infection during endoscopy: is it the "tip of the iceberg" or the absence of ice? Gastrointest Endosc 2007; 65(4): 589-91.

Mikhail NN, Lewis DL, Omar N, Taha H, El-Badawy A, Abdel-Mawgoud N et al. Prospective study of cross-infection from upper-GI endoscopy in a hepatitis C-prevalent population. Gastrointest Endosc 2007; 65(4): 584-8.

Vanhems P, Gayet-Ageron A, Ponchon T, Bernet C, Chayvialle JA, Chemorin C et al. Follow-up and management of patients exposed to a flawed automated endoscope washer-disinfector in a digestive diseases unit. Infect Control Hosp Epidemiol 2006; 27(1): 89-92.

Morris J, Duckworth GJ, Ridgway GL. Gastrointestinal endoscopy decontamination failure and the risk of transmission of blood-borne viruses: a review. J Hosp Infect 2006; 63(1): 1-13.

Nelson DB. What is the risk of transmission of hepatitis C virus during digestive endoscopy? Nat Clin Pract Gastroenterol Hepatol 2005; 2(12): 560-1.

Notes

Registries should ensure compliance local/national legislation, which may stipulate a different minimum deferral period following surgery and endoscopy.