COVID-19 crisis slows organ transplants nationwide
Friday, May 01, 2020
As ICUs have filled up with COVID-19 patients, the number of organ transplants have decreased significantly nationwide.
Data from the United Network for Organ Sharing (UNOS) showed transplants decreased sharply in early March. By the last week of month, half the number of transplants were performed as in the first week. According to the UNOS, there were about 900 transplants the week of Feb. 16. By March 29, that number had fallen to 437.
Living donor programs have seen the most significant drop. Donors and recipients are hesitant to go into a hospital for fear of contracting the virus. There were about 150 living donor transplants the week of March 15 and only 15 the week of March 29.
"Pretty much, it's shut down," said Arthur Caplan, a bioethicist at NYU Langone Health, of the nation’s organ transplant system. "A lot of people may die on the waiting list, more than usual."
A lack of donors is complicating the problem. COVID-19 patients aren't eligible donors, and social distancing measures have lowered the number of traumatic accidents like car crashes. The availability of commercial airline flights is also proving a challenge.
Organ procurement personnel routinely fly needed organs across the country where a transplant patient is waiting. But with fewer flights available, getting organs where they need to go doesn't always happen, meaning doctors must rely on local donations.
“Patients that are now on the waitlist are even more fearful than they were before,” said Helen Irving, CEO of LiveOnNY, an organ procurement agency. In normal months, around 30 families agreed to donate organs from a deceased loved one. Irving said she expects less than 10 families to make that choice in April.
Hospital resources are also stretched to the limit. Not only staff and operating rooms have been redeployed but also ventilators, which are used to keep brain dead patients oxygenated until transplant surgery can occur.
Despite the challenges, transplants are typically considered emergency surgery. Irving said a few emergency transplants are occurring in the New York area, but patients who can survive using dialysis will have to wait. Pancreatic transplants are on hold indefinitely, and heart patients who can wait a few weeks will be asked to do so.
“We will be doing our best,” Irving said, but “it won't be what it was a few months ago."
The situation is the same in Washington state, one of the early hot spots for COVID-19. “From the transplant perspective, all transplants are considered emergencies. It’s like trauma: There are patients that are listed we know are going to get sick and die if they don’t get an organ,” said Dr. Jorge Reyes, chief of transplant surgery at University of Washington Medicine. “Having said that, we may feel certain patients could wait.”
Transplant physicians also must weigh the anticipated needs of the organ recipient. “Our ability to do a liver transplant is not always just about the [risk of COVID-19] exposure to the patient,” said Dr. David Mulligan, chief of transplantation surgery and immunology at Yale.
“It’s also, do we have a bed? Do we have a ventilator to take care of the patient? Can we isolate the patient from other COVID-infected patients? Do we have enough time to do this operation, get them through it, keep them away from COVID, and then get them out of the hospital safely? That’s what we’re shooting for.”
Despite 2019 being a record year for organ donations, procurement organizations expect numbers to remain low through the summer.
“We think that our activity levels will actually drop off in April and May and then we think in June and July things will come back up and, by July, we will be back to a new normal,” said Kevin Myer, CEO of LifeGift, a Houston-based organ procurement organization.
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