Organ donation and transplantation during COVID-19 pandemic has been a challenge that has never been faced by the programme in all these years since its inception. The first three months saw hardly any transplant activities in the country. Most cities doing majority of transplants have been in the red zone and it was only Kerala that was less affected that managed to do some deceased donations followed by Pune and Hyderabad. From April to June 2020, this was the data

●       Kerala had six deceased donors that resulted in six pairs of corneas being donated, 11 kidney transplants, four liver transplants, and two heart transplants

●       Pune had five deceased donors that resulted in four kidney transplants, five liver transplants, and two kidney-pancreas transplants

●       Hyderabad had five deceased donors that resulted in four pairs of corneas being donated, six kidney transplants, and four liver transplants

The Indian Society of Organ Transplantation has during the pandemic issued two sets of guidelines and the second updated one was accepted by the National Organ and Tissue Transplant Organization (NOTTO) as national guidelines. These are available on their websites (www.isot.co.in and www.notto.gov.in). Almost all government tertiary care hospitals are serving COVID patients and the transplant programme is unlikely to start in these hospitals until the pandemic shows signs of receding. Recently a few private hospitals have restarted the programme. However before restarting the programme the transplant team needs to take into consideration the risk-benefit ratio. It needs to ensure that adequate protection, staffing and infrastructural support is available. Other considerations include the following- Decision making Process: If in certain organs the risk of death is higher due to waiting, for example, in a fulminant liver failure or a severely decompensated liver failure patient with a high MELD score or a sick heart or lung failure patient. With kidney transplants dialysis is always an option, however here too the cost of dialysis can be an issue for a patient who is ready for transplant. There is also the issue with safety of healthcare professionals and the danger of transmission of COVID-19 from patients to the potential recipients and donors that needs to be taken into consideration. Every unit needs to look at the current trends in their city and the available ICU facility in the hospitals before restarting a transplant programme. Consent Process: All transplant recipients and donors should fully understand the potential risk of COVID-19 infection during hospital stay and after transplant and then sign the fully documented informed consent form. Transplant Teams: Ideally if feasible the transplant team should define two teams which are separate and not working together and which should have independent transplant surgeon, physician and intensivist so that all surgical and medical problems can be handled if one team gets quarantined or exposed. The teams can alternate for each patient. This issue carries three articles on various aspects of organ transplants covering kidneys, lungs, and the psychological impact of COVID-19 that would be useful reading to the transplant community in making decisions for themselves in these unusual Times.