As Covid-19 continues to place multiple nations under lockdown, some of the worst affected countries have reported a sharp reduction in organ donations and transplant procedures. A new study published in The Lancet details how France and the United States have been suffering from reduced transplants since early April compared to previous months, seeing a 91 percent and 50 percent fall in procedures, respectively.
"Our findings point to the far-reaching and severe ripple effects of the Covid-19 outbreak on health care, including life-saving organ transplants," said study co-author Peter Reese, an associate professor of Medicine and Epidemiology at Penn, in a statement. "Organs from deceased donors represent a time-limited opportunity, as they must be procured and used rapidly. However, in order to protect the safety of their patients, centers must now carefully vet all donors to ensure there is minimal risk of Covid-19."
The international team of transplant scientists working on the study included experts from the Perelman School of Medicine at the University of Pennsylvania and Paris Transplant Group. They report that the overall decline is largely attributed to a steep reduction in kidney transplants, though there has also been a reduction in the number of heart, lung, and liver transplant procedures.
The outbreak has complicated the organ donation process as transplant centers, including the Penn Transplant Institute (PTI), are unable to use organs from deceased individuals who showed evidence of infection or exposure to the SARS-CoV-2 pathogen. While Covid-19 has caused a spike in death rates in the worst affected countries, transplant centers are unable to fulfill the wishes of registered donors who die from the disease and though some organ donations are taken from living donors, the vast majority are still facilitated by deceased donors.
The study investigators carried out a comparison of national data from three agencies, including the United Network for Organ Sharing (UNOS), to examine transplant trends in France and the United States both before and after the Covid-19 outbreak first began. Their findings indicated a correlation between the number of infections with the SARS-CoV-2 pathogen and a significant decline in donated organs and transplant procedures. In the United States, the number of harvested organs fell by more than half from March 6 to April 5, dropping from 110 a day to fewer than 60. The same period saw a reduction in kidney transplants from nearly 65 a day to about 35 a day. The researchers also hypothesized that lockdown measures may have impacted the observed 91 percent drop in transplants in France, as they enforced widespread measures to reduce clinical and commercial activity. The team suggest that the comparatively small reduction of 50 percent observed in the US could be due to individual states being permitted to impose their own restrictions regarding social distancing and hospital practice during the same time period.
"These international comparisons of transplant activity will be very important as the Covid-19 pandemic evolves," said co-author Alexandre Loupy, a nephrologist at the Department of Nephrology and Kidney Transplantation at Necker Hospital in Paris and Head of the Paris Transplant Group, in a statement. "Some transplant systems may develop best practices to support organ procurement and transplant that can be shared across borders. We have a lot of work ahead to restore our invaluable infrastructure of donation and transplant surgery."