When an organ fails, it is surgically removed from the donor and implanted into the recipient, who is the transplant receiver. The liver, kidney, pancreas, and heart are among the organs that can be donated. This surgical procedure is very complex and is used in cases of extreme illnesses when other treatment methods have failed to help a patient sustain their health. COVID-19 has become a challenge for the global healthcare system, and although organ donation is not directly linked to this condition, some new trends with transplantation have emerged as well. For one, the exposure to COVID-19 of the donors required healthcare professionals to alter how the transplants were selected to ensure no infected tissues. The COVID-19 pandemic has created a shortage of donated organs, especially for individuals with kidney failure who depend on organ transplantation as the only treatment option.
Organ donation and transplantation have been a single treatment method for patients with severe illnesses causing organ failure. Due to the nature of the transplantation procedure, patients requiring it would need to be on a waitlist until an organ with suitable physiological characteristics becomes available (Kute et al., 2022). Hence, some patients who require transplantation could wait for years or never receive their transplant at all. Moreover, in the United States, organ donorship is voluntary, and it is forbidden by law to sell or purchase human organs (Kute et al., 2022). Thus, patients with severe illnesses rely on the citizens who choose to donate their organs for transplantation, as this is the former’s only chance to survive.
Prior to the pandemic, patients already had to be on a waitlist, some for years, to receive the organ transplant they needed. According to research by Merola et al. (2021), fewer organs were donated after the onset of the COVID-19 pandemic. The capacity to properly recover organs and execute transplants has been affected by the possibility of virus transmission from donors to recipients or to and from medical professionals. Transplantation of solid organs is regarded as being absolutely required and vital (Merola et al., 2021). Many patients with stable illnesses and those awaiting scheduled living donor transplants were able to safely postpone surgery until after the pandemic’s incidence peak had passed. However, COVID-19 forced the transplantation centers to change their screening policy to ensure that recipients do not get infected. Each transplant center thoughtfully decides whether to move through with the transplant (Merola et al., 2021). Most of the time, living donor transplantation, particularly liver donation, was postponed, allowing healthy donors to adhere to the advised stay-at-home recommendations (Merola et al., 2021). In any case, the transplantation centers had to alter their donor transplantation policies, and living donors, in many cases, had to quarantine or postpone their procedures due to fears of being infected with COVID-19.
The pandemic developed gradually and affected different areas of the United States with varying severity. Thus, the effect of COVID-19 on the organ donation and transplantation process has not been noticed until fairly recently. Depending on the incidence and prevalence of COVID-19, this disease process had a diverse impact on different regions of the United States at different times. Between February and April 2020, there were more than 25% fewer liver transplants nationwide as a result of significantly reduced organ recovery rates and living donation (Merola et al., 2021). In the event of another wave of COVID-19, a similar halt in transplantation may occur again.
The official statistics of the United States government also support the idea that with the onset of the pandemic, the number of organ transplantation procedures has decreased. According to the Organ Procurement & Transplantation Network (2021), “A total of 5,725 living donor transplants were performed in 2020, a decrease of 22.6 percent over the record of 7,397 set in 2019” (para. 1). While the pandemic disproportionately reduced the availability of healthcare services in some regions of the nation, deceased donation rates increased across the board.
The pandemic appears to be the main cause of the reduction in the number of organ transplantation cases. Before its onset, the number of transplantation surgeries in the United States had been increasing continuously yearly. Based on the statistics of the Organ Procurement & Transplantation Network (2021), of the 58 organ procurement groups in the country, 38 had a rise in donations in 2020 compared to those in 2019. A large portion of the increase in deceased donations was made possible by donors who did not meet the usual medical requirements. The age range of dead donors that was most prevalent for the second consecutive year was 50 to 64 (Organ Procurement & Transplantation Network, 2021). The 3,726 donations in this category represent an increase of 7.9% from 2019. Donations increased significantly among people who passed away from cardiorespiratory failure as opposed to brain death; there were 3,223 DCD donors in 2019, an increase of 18.6% from the total in 2019 (Organ Procurement & Transplantation Network, 2021). All of these factors contributed to the availability of healthy organs available for transplantation to patients in need of them.
The COVID-19 pandemic had a more significant impact on the number of living donor transplants that the clinics carried out. Due to worries about unnecessarily exposing potential live donors and living donor recipients to potential COVID-19 infection, many transplant programs temporarily delayed living donor transplantation in locations that were particularly afflicted by COVID-19 outbreaks. According to Organ Procurement & Transplantation Network (2021), 5,725 living donor transplants were completed in total in 2020, which is a 22.6 percent decline from the record-breaking 7,397 transplants carried out in 2019. However, since June 2020, the number of living donor transplants has increased at a rate more akin to pre-pandemic activity. A total of 39,034 transplants from both live and deceased donors were carried out in the United States as a result of the reduction in living donor transplantation. Although it is the second-highest annual amount of transplants overall, the record of 39,719 set in 2019 has been marginally surpassed (Organ Procurement & Transplantation Network, 2021). Therefore, as the healthcare system adapts to post-pandemic life, the number of organ transplants is returning to the pre-pandemic values.
Most importantly, it is unclear how this trend will affect donor transplantation in the United States. COVID-19 has changed the resource allocation within the healthcare system. Moreover, it made it necessary for transplantation centers to take more steps of precaution to ensure that donors and recipients are healthy.
Some precautionary measures have already been implemented by the responsible agencies to ensure that organ donation is safe. For example, testing for COVID-19 and donor history are now commonplace components of the donor assessment procedure (Domínguez-Gil et al., 2020). In a perfect world, there would be no history of SARS-CoV-2 exposure or symptoms that would point to a coronavirus infection, as well as quick access to accurate diagnostics and the required imaging tests. Even with testing, however, there has been some direct coronavirus transmission from asymptomatic individuals (Domínguez-Gil et al., 2020). Additionally, there are considerable false-negative outcomes with the present tests, and testing techniques are not nationally standardized. Moreover, even while society guidelines do not suggest its use as a regular screening method, access to sensitive imaging is not always easy to come by, such as computed tomography of the chest.
Significant changes were made in reaction to the pandemic in many organ donation facilities. Ahmed et al. (2020) report that measures such as reducing staff presence on-site and switching to telephone methods for donor family correspondence. The contemporary environment has witnessed substantial changes in organ donation, but it is still unclear what these changes will mean in the long run. Further research is necessary to meet unmet demands, prepare for a proportionate virus response, and lessen the collateral damage as a result of these developments during the COVID-19 era. Ahmed et al. (2020) state that they anticipated that the present COVID-19 issue may have had an impact on donor volume, organ yield, and service activity based on prior observations in the surgical literature and the functionality of existing social distancing measures and health policy guidelines. Two crucial questions to examine are how this pandemic has affected organ donation and how long it would take to manage a potentially expanding waiting list.
Since the earlier editions of the recommendations, the requirement for screening potential recipients prior to transplantation. A commonly used method for screening is the RT-PCR test of nasopharyngeal samples, which has been established, with the transplant process being delayed in patients testing positive or with a suggestive clinical picture (Domínguez-Gil et al., 2020). Despite some reports suggesting a higher sensitivity computer scan compared with RT-PCR testing in patients with symptoms of COVID-19, no firm recommendation was proposed in this regard for recipient evaluation due to logistical issues and the expected low pretest probability among otherwise asymptomatic candidates (Domínguez-Gil et al., 2020). Therefore, the cause of the decrease in the number of organ donations has not been addressed substantially, which may be a barrier for people who want to become organ donors.
The disparity in deceased donation decline among regions highlights the need to improve deceased donation policies and practices to ensure that organ donation levels continue to increase. The deceased donation is anticipated to be particularly vulnerable during upcoming pandemics. New high-level data collected by Kute et al. (2022) confirm that successful deceased donation programs also produce positive results. Several locations avoided organ donations during the pandemic’s initial phase because of the concern of extended hospital stays and a higher likelihood of complications. Hence, more policy-related work is needed to address the decline in organ donations post-COVID-19.
In summary, the COVID-19 pandemic has caused a shortage of donated organs, particularly for kidney failure patients for whom organ transplantation is the only available form of treatment. The cause of this issue is the potential for virus transmission from donors to recipients or to and from medical staff. This issue has impacted the ability to retrieve organs and perform transplants, therefore reducing the number of organ donations that are vital for some patients.
References
Ahmed, O., Brockmeier, D., Lee, K., Chapman, W. C., Doyle, M. B. (2020). Organ donation during the COVID-19 pandemic. American Journal of Transplantation, 20, 3081– 3088. Web.
Domínguez-Gil, B., Fernández-Ruiz, M., Hernández, D., Crespo, M., Colmenero, J., Coll, E., & Rubio, J. (2020). Organ donation and transplantation during the COVID-19 pandemic: A summary of the Spanish experience.Transplantation, 105(1), 29-36. Web.
Merola, J., Schilsky, M.L. and Mulligan, D.C. (2021), The impact of COVID-19 on organ donation, procurement, and liver transplantation in the United States. Hepatology Communications, 5, 5-11. Web.
Kute, V., Tullius, S., Rane, H., Chauhan, S., Mishra, V., & Meshram, H. (2022). Global impact of the COVID-19 pandemic on solid organ transplant. Transplantation Proceedings, 15-20. Web.
Organ Procurement & Transplantation Network. (2021). Annual record trend continues for deceased organ donation, deceased donor transplants. Web.