Solid organ transplantation improves survival and quality of life for patients with end-stage organ disease. However, transplant procedures involve increased susceptibility to infection and a substantial investment of healthcare system resources, making it challenging to transplant programmes smoothly with the emergence of the pandemic, resulting in a significant decline in transplant numbers during a pandemic all over the world. Dr Anuja Porwal, Additional Director & Head Department of Nephrology and Kidney Transplant medicine, Fortis Hospital Noida, shares factors responsible for post-pandemic organ donation cases.
Living Donor-Based Transplant
Transplant surgeries are performed in tertiary care centres in our country. However, during the lockdown and travel restriction era, it was almost impossible for patients and their families to travel to metro cities for the transplant workup and surgery and arrange logistics for staying near the hospitals.
Living donor-based kidney and transplant programs in India have also resumed full vigour. However, the deceased donor/ Cadaveric based donation and organ transplants have taken a hit because of the pandemic to such an extent that Cadaveric donations had almost halted during the pandemic. However, there has been a steady rise in the numbers in the last 6-8 months.
Deceased Organs For Transplantation
Travel restrictions across states during the pandemic severely affected the movement of deceased organs for transplantation to those that need them most. There also have been concerns at the beginning of the pandemic that organ transplant recipients who are on medications that reduce body immunity are more prone to infection with Covid-19 or have a more severe course of illness, making patients, their families as well as physicians reluctant to aggressively pursuing transplant and organ allocation.
With the earned wisdom over time, it has been consistently shown that the use of most transplant medications is safe and may prevent severe symptoms by blocking the cytokine storm. Furthermore, the outcome of the Covid-19 infection is the same, if not better, in organ transplant recipients. Therefore, it is no surprise that transplant activity has resumed in the country after initial apprehensions as Covid-free pathways have been widely established.
For thousands of patients who keep waiting for an organ to be allotted to them, the wait might have become excruciatingly longer.
As transplant teams saw hundreds of patients losing the battle of life while waiting for organ transplantation during the pandemic, the importance of the benefit-risk ratio stood out in stark reality.
It has compelled us to reconsider establishing more effective transplant programmes regarding resources. It has also forced us to consider whether transplant surgery is truly elective or whether it is time to count it as semi-urgent or urgent.
This emphasizes the need to optimize cadaveric donation policies and practices in developing countries, with cadaveric donations and transplants expected to be most vulnerable during future pandemics.
In the initial phase of the pandemic, many regions have avoided donations after cardiac death and marginal organs for fear of prolonged hospital stays and a higher probability of complications.
You may like to read
Therefore, optimizing the balance between available resources with enhanced utilization of available organs will be most relevant in preparing for the next pandemic. Additionally, support by the global community to strengthen deceased donor programs will help improve transplantation.
Finally, effective policies and risk stratification may help to move transplantation forward in future pandemics.
Hence an early decision for organ donation from the family's side is crucial for maintaining donated organ quality.