TMC PULSE

16 t m c n e w s . o r g How COVID-19 Impacted Organ Transplants Organ donations and transplants declined early in the pandemic I n the early days of COVID-19, the illness slowed the transfer of vital organs for transplants and added new precautions to the transplant process. Testing for the disease caused by the novel coronavirus now extends to deceased persons who receive the same nasal swabs that make living patients flinch. In addition, the public's limited movement in the early pandemic period, thanks to stay-at- home orders and social distancing, meant fewer of the accidents and other traumatic events that generate organ donation. Some people antici- pating transplants were inactivated, temporarily, from the national waitlist because of the corona- virus crisis. Despite the dwindling supply of organs available, surgeons also declined organs from coronavirus hot spots. In addition, concern about the availability of personal protective equipment halted live donor transplants at Houston-area transplant centers. "We are not recovering organs and transplant B y C i n d y G e o r g e centers are not transplanting organs from donors who have positive tests for COVID-19," said Kevin Myer, president and CEO of LifeGift, a Houston- based organ procurement organization that serves 109 Texas counties and more than 200 hos- pitals, including transplant centers in the Texas Medical Center. "Depending on where you are in the country—obviously in New York and Seattle and in other places—transplantation slowed down, but it didn't stop." New procurement protocol As part of the new pandemic procedure, a poten- tial donor's next-of-kin is questioned about the person's travel history as well as exposure to various diseases and infections, including the novel coronavirus. "We are recovering a sample, a nasal swab, for COVID-19 testing," Myer said, adding that the additional process with test results in about 24 hours began in mid-March. "If we get a positive test back, we would stop the case." Other adjustments in the acquisition of organs include restricting travel. Typically, a LifeGift perfusionist and transplant surgeons recover an organ in person. Now, operating surgeons depend on their capable counterparts to match an organ in one place to a patient in another. The shift affected LifeGift's donor and trans- plant tallies, which dropped by about half from February to March. "For March, we recovered 31 organ donors and transplanted 97 organs. For us, that's a little bit lower than what we typically do in a month, but we did not experience the massive drop some other areas have had," Myer said, adding that February was LifeGift's busiest month ever. "We recovered 54 organ donors and transplanted about 186 organs in February." Transplant centers adjust After attending a late-February transplant con- ference in Phoenix where a Canadian colleague left early because of his country's public health emergency, J. Steve Bynon, M.D., chief of abdom- inal transplantation at Memorial Hermann-Texas Medical Center, returned to Houston and assem- bled his team to discuss COVID-19. "I said: 'This is going to be a major problem. We need to not expose our patients. We don't know who has it and who doesn't; that's one of the problems without extensive testing. We need to cancel all of our post-transplant clinics because those people are immunosuppressed and we don't want to expose them, potentially, to other people who have it,'" Bynon recalled. The hospital turned to telemedicine options for recently discharged transplant patients. Live transplants were canceled to save personal protec- tive equipment and ventilators. "When you have a health care crisis like this, you have to change gears very quickly and conserve resources," said Bynon, a professor of surgery at The University of Texas Health Science Center at Houston (UTHealth) McGovern Medical School. "We decided we would not take organs from areas of the country that had high incidences of COVID. We would not take any organs from donors that we thought would be high risk from their method of death, such as French physicians, who removed part of a liver from a living donor, prepare to transport the graft in an insulated container. Credit: Phanie / APHP-St ANTOINE-GARO, Medical images.com

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