Organ transplant plunges as coronavirus spreads

Organ transplants plunged as coronaviruses hit the community. Surgeons endanger live donors and are wary of not being able to recover potentially dead organs. Even if the doctors were motivated and competent, the hospitals that treated COVID-19 patients were sometimes overcrowded.

Transplantation of dead donors between late February and early April — the most common type — In the US it fell by about half and in France it plummeted by 90%, The researchers reported Monday in a lancet magazine.

According to transplants from living donors, diving was also astonishing United network for organ sharingOperates a US transplant system. In the second week of March, when the pandemic was declared, there were 151 living donor transplants in the United States. By the week of April 5, there were only 16 such transplants, according to UNOS.

It’s too early to know how many people awaiting life-saving organ transplants could die because of a pandemic blocking a chance at a new organ, instead of dying from a COVID-19 infection. Kidney transplant It accounted for the majority of the decline, but heart, lung and liver transplants were also reduced.

Living donations may be rescheduled, but missed organs from deceased donors will lose opportunity, the lead research team wrote Dr. Alexander Loopy, A nephrologist who heads the Paris Transplant Group.

Geographic change could provide important lessons Dr. Peter ReeseIs a transplant nephrologist and epidemiologist at the University of Pennsylvania involved in lancet research.

“The transplant center and the patient really want to go again, but I have all these questions,” says Lease, looking closely from the team’s Canada and other parts of Europe. “We need to find a place to keep their port rate and what they did.”

Hospitals around the world Postponed all types of medical care They were flooded with COVID-19 patients. Porting decisions are the most difficult. Although they are not elective surgery, patients must take immunosuppressive drugs to prevent rejection of new organs. When a virus is encountered, the patient is at greater risk.

The larger decline seen in France may have been due to more centralized public health policies than state-to-state fluctuations in the US, Reese said.

“The equation depends on where you are in the country.” Dr. Abinaf Humaar, Chief of Transplantation, University of Pittsburgh Medical Center. His transplant center is still in operation, accepting patients in New York and other more devastated areas that need a new liver, willing to live with donors, and “at least a few We don’t have the luxury of waiting months. ” Their original hospital was able to get them back.

In an average month, New York makes about 220 transplants across the state. In the first few weeks of April, it had fallen to 23, said Samantha Delea of ​​the New York Liver Transplant Center at a recent UNOS video conference.

In contrast, the University of California, San Francisco said it has experienced a small drop in transplants. Dr. Chris Fries, There is a temporary transplant director.

“ We are one of the few centers that have continued to experience all this, but it hasn’t been without careful consideration, ” daily updates are needed to determine which transplants are safe. Said the milling cutter. He said he remained vigilant while California’s social distance restrictions were gradually lifted.

For example, Freise’s team allowed people like Herb Hoeptner in need of dialysis kidney transplants.

“If you have nothing left in your kidneys, you’ll either be on dialysis or you’ll die. It was much more worrying than coronavirus,” heptner said.

A 66-year-old from Gilroy, California, he realized how rare transplants during a pandemic were only after his March 31 surgery.

“I was very lucky,” adds his wife, Diane, as his donor, and Heptner, who quickly recovered from surgery.

Where COVID-19 is more prevalent, living donors are naturally nervous. “There’s still no way to discuss what a reasonable risk is with a living organ donor,” Reese said.

Dead donations are more complicated. At an early stage, it was difficult to test shortages to make sure that donors who would have died in an unrelated thing like a car crash were not infected with the virus. Still, the hospital does not want out-of-town surgeons to visit to retrieve organs, and local surgeons do not always have time to work.

The surgeon should weigh if it makes sense to accept a less than perfect organ that might work but could keep the recipient in the hospital longer.

Dr. David Axelrod A kidney surgeon at the University of Iowa said his team said, “We’re trying to pay attention to that, and it’s an organ that we think people can come in with, have a successful transplant, and go home immediately.” I’m trying to make sure it’s there. “