‘Amazing’ recovery of donations, transplant rate seen during pandemic
Click Here to Manage Email Alerts
Organ donation and kidney transplants have made an “amazing” recovery from the worst days of the pandemic, a speaker said here, with more than 33,000 kidney transplants performed in 2020.
“There were some parts of the Northeast where there were zero living donor transplants done for weeks,” Matthew Cooper, MD, director of Kidney and Pancreas Transplantation at Medstar Georgetown Transplant Institute and professor of surgery at Georgetown University School of Medicine, said during a presentation at the virtual National Kidney Foundation Spring Clinical Meetings. “It was amazing how the country regained ... the key was getting organs to areas where transplants could happen.”
During the week of April 6, 2020, only 16 living donors were transplanted. As a sign of the recovery, more than 405 transplants were performed in 1 week later that year, Cooper said. “More decreased donors were recovered in 2020 than 2019 – absolutely amazing,” Cooper said. In total, 33,320 decreased donor kidney transplants were performed in 2020, according to data from the United Network for Organ Sharing. Cooper is the incoming president of the organization. “This is really a remarkable story that I hope will continue to play out in the future,” he said.
Concerns about the virus
In a survey conducted in the early months of the pandemic, transplant physicians and surgeons expressed concerned about the risk of COVID-19 in relation to accepting organ donors and performing transplant surgery, Cooper said.
With a 79.3% response rate, 85.1% of transplant leaders “were either highly concerned or extremely concerned about risks of COVID-19 in recipients,” Cooper said. “This was across the country, so regardless of the time where [the virus] was and regardless of the number of cases in that area, there was certainly an overwhelming concern among transplant surgeons.
“That led to a significant stoppage of transplant programs across the country.”
More than 70% of centers suspended living donor kidney transplants programs, and 80% limited operations for decreased donor transplants to patients being treated with in-center dialysis, those who lacked a vascular access, highly sensitized patients and if the organ available for transplant was of high quality. As a result of the spread of the virus, living donor cases per day declined by 87% across the United States and deceased donor cases per day declined by 23.9%, Cooper said.
“We still consider, at least in the kidney transplant space, that the kidney is a life-saving organ, and to continue with transplants during the pandemic, we had to restrict or change our views on who we thought were the best patients,” Cooper said.
Deaths on the waitlist
The challenge was realizing that as the number of transplants slowed, the number of deaths on the waitlist increased. “We had to balance – with caution – whether we had the proper environment to do transplants and the infrastructure, but we also recognized that deciding to not do transplants was not such a simple answer [to the pandemic],” Cooper said. “We knew that people would die waiting for their transplant.”
The risk, Cooper said, was real, starting in the dialysis units. One study of two in-center dialysis clinics showed a 36.2% (129/356) prevalence rate of COVID-19 with 40.3% (52/129) of those patients being asymptomatic.
“The patients most at risk were those with more comorbidities,” Cooper said. “These were the patients that suffered the most – things like hypertension and diabetes. Folks that had these comorbidities in addition to having the virus had a higher risk of death.”
In terms of risks for transplant recipients, “current transplant guidelines indicate that the risk of acquiring COVID-19 from a donor organ is very low,” Cooper said. “All deceased donors are tested for COVID, and only negative donors can proceed. There have been no documented cases of donor-derived COVID transmission,” Cooper said.
Collapse
Cooper, M. #271. Presented at: National Kidney Foundation Spring Clinical Meetings (virtual meeting); April 6-10, 2021.
Read more about
Click Here to Manage Email Alerts