RSC0003

Written evidence submitted by Leher Gumber and Dr Anil Gumber

 

  1. Coronavirus disease 2019 (COVID-19) is an ongoing public health emergency and presents immense challenges to healthcare services. Within the UK, more than 272 000 people have tested positive and 38 000 deaths have occurred as of 31 May 2020 [1]. To limit transmission of the virus, the British government implemented strict quarantine, social distancing, self-isolation and hand hygiene measures on 23 March 2020 in accordance with the World Health Organization guidelines [2].

 

  1. Currently, much of the attention is on finding treatment, developing a vaccine, re-establishing the economy and containing the virus. A largely neglected area is the potential implications of COVID-19 on organ donation and transplantation. End-stage organ failure is estimated to affect more than six million people worldwide. There is a growing concern that the added burden on hospitals during the current pandemic particularly in intensive care settings may limit their ability to perform transplants and care for recipients.  

 

  1. Guidelines for organ transplantation programmes are beginning to emerge in some countries. In the Sichuan Province of China living donors, transplant recipients and their families are being screened. However any recipients from high risk areas are not being offered transplants [3]. Italy observed a 25% reduction in organ procurement during the initial phase following which guidelines were produced to ensure both routine and urgent transplant activity is maintained. At present all donors are screened and only negative donors are considered [4]. Similar recommendations have been provided by the American Society of Transplant Surgeons [5]. In contrast, Canada has adopted a precautionary approach suspending all kidney transplants whilst liver transplants are being assessed on a case by case basis [6].

 

  1. The ongoing pandemic has presented several challenges for transplantation services in the UK. NHS Blood and Transplant (NHSBT) is advising clinicians to screen all deceased donors and COVID-19 patients are automatically excluded from the donor register [7]. Many transplant centres across England are closed and there has been a complete cessation of living donor and a drastic reduction in deceased donor transplants. NHSBT data shows a 72.8% reduction in deceased donor transplants in April 2020 compared to April 2019 [8]. Based on this, we have estimated that there could be 904 fewer transplant surgeries in the three-month period of March to May 2020 (Table 1). This is a net addition of approximately 16% to the current waiting list which includes 5699 patients (as of 1 April 2020) [9]. This has enormous implications for the median time to transplant which currently stands at 706 days in the case of kidney. Further divided by ethnicity, the median time to kidney transplant is 830 days for Asian and 965 days for Black (compared to 640 days in white Caucasians) at present. Thus, the greatest impact could be seen in the Black, Asian and Minority Ethnic community prolonging the wait time to three years.

 

 

Organ Transplant Activity 2019/20201

 

Shortfall in COVID-192

 

Total

First 3 Quarters (Apr-Dec)

Last Quarter (Jan-Mar)

Average Shortfall in Last Quarter

March

April

May

Total

Deceased Donor (DD)

3762

2915

847

125

199

236

236

671

Living Donor (LD)

1001

770

231

25

61

86

86

233

Total Donors

4763

3685

1078

150

260

322

322

904

Notes: The organ transplant activity has been divided into two subperiods. The last quarter is affected by COVID-19 outbreak, whereas the first 3 quarters are considered as the normal.

 

1 The average number of transplants conducted per month during the first 3 quarters (normal) were 324 for DD and 86 for LD.

2 The shortfall is calculated based on the 72.8% reduction in DD cases between 01/04/2020 and 26/04/2020 as reported in the Organ Donation and Transplantation data. No LD cases were performed during the COVID-19 lockdown period.

Table 1. Estimated Shortfall of Organ Transplants in March-May 2020 in the UK by Donor Type [8,9]

 

  1. To the best of our knowledge, this is the first assessment of the effect of COVID-19 on organ donation and transplantation services in the UK. As the virus continues to spread, transplant professionals will have tough decisions to make and several questions still remain unanswered. How long will the lockdown of organ transplantation services continue? Will transplantation services remain suspended until a vaccine is developed? Previous data has shown that over one third of healthy kidneys were transplanted from deceased donors aged 60 and over [10]. Therefore, deceased donor transplants from COVID-19 patients with healthy kidneys should be considered to save the lives of transplant patients and reduce the added burden on services before a vital opportunity is lost.

             

References

1               United Kingdom Coronavirus: 272,826 Cases and 38,376 Deaths - Worldometer. https://www.worldometers.info/coronavirus/country/uk/ (accessed 31 May 2020).

2               Sparrow A, Campbell L, Rawlinson K. UK coronavirus: Boris Johnson announces strict lockdown across country – as it happened. The Guardian. 2020.https://www.theguardian.com/politics/live/2020/mar/23/uk-coronavirus-live-news-latest-boris-johnson-minister-condemns-people-ignoring-two-metre-distance-rule-in-parks-as-very-selfish (accessed 2 May 2020).

3               Pan L, Zeng J, Yang H. Challenges and countermeasures for organ donation during the SARS-CoV-2 epidemic: the experience of Sichuan Provincial People’s Hospital. Intensive Care Med Published Online First: 25 February 2020. doi:10.1007/s00134-020-05978-8

4               Angelico R, Trapani S, Manzia TM, et al. The COVID19 outbreak in Italy: Initial implications for organ transplantation programs. Am J Transplant 2020;:ajt.15904. doi:10.1111/ajt.15904

5               American Society of Transplant Surgeons. ASTS COVID-19 Strike Force Organ Retrieval Guidance. 2020.https://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force/asts-covid-19-strike-force-organ-retrieval-guidance#.XrsbKhNKiqA (accessed 12 May 2020).

6               Canadian Blood Services. Consensus guidance for organ donation and transplantation services during COVID19 pandemic. Canadian Blood Service 2020. https://profedu.blood.ca/sites/msi/files/20200427_covid-19_consensus_guidance_final.pdf (accessed 2 May 2020).

7               NHS Blood and Transplant. COVID-19 Assessment and Screening Flowcharts - DAT3737/4. NHS Blood and Transplant 2020. https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/18151/dat3737-added-300320.pdf (accessed 2 May 2020).

8               NHS Blood and Transplant. Organ Donation and Transplantation - Activity figures for the UK as at 1 May 2020. NHS Blood and Transplant 2020. https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/18294/weekly-stats.pdf (accessed 3 May 2020).

9               NHS Blood and Transplant. Organ Donation and Transplantation - Annual Activity figures April 2020. NHS Blood and Transplant 2020. https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/18279/annual_stats.pdf (accessed 1 May 2020).

10               NHS Blood and Transplant. Organ Donation and Transplantation Activity Report 2018/19. NHS Blood and Transplant 2019. https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/16537/organ-donation-and-transplantation-activity-report-2018-2019.pdf (accessed 2 May 2020).

June 2020