By Kaitlyn Foster and Simi Juriasingani

The COVID-19 pandemic has taken the world by storm since its emergence in early 2020, as the virus has spread across every continent in the world. The severe acute respiratory illness caused by the virus has not only infected and taken the lives of millions, but has also had a large impact on many areas of clinical practice including organ donation and transplantation. As a result, the allocation of healthcare resources in hospitals across the globe has shifted towards fighting, treating and controlling the pandemic. This has led to a sharp reduction in organ donation and transplantation worldwide, as elective clinical procedures were put on hold in many affected countries, including Canada. 

As the knowledge about COVID-19 virus continues to expand, it is crucial that individuals are aware of the new protocols  for organ donations and transplants that have been put in place to keep everyone safe. A few of the most important and commonly asked questions regarding COVID-19 and organ donations are addressed below. 

Has there been a significant reduction in organ donation during the pandemic? 

Yes, there has been a decrease in organ donation and it was especially exacerbated during the period with stay-at-home orders. However, as the stay-at-home orders have begun to lift during the lockdowns, donations have slowly been returning to normal levels. Countries that were negatively impacted in terms of organ donation and transplantation during the pandemic include the United States, France, and the United Kingdom. These countries had a record-breaking number of COVID-19 cases and report more than a 50% reduction in transplant activity. Elective transplants were also put on hold in Canada for several  months at most healthcare centres due to the pandemic. This modification to increase resources for the COVID-19 pandemic and reduce the risk of infection has delayed many transplants and they are still progressing at a slower rate than prior to the pandemic.

Are all organ donors being tested for the COVID-19 before transplantation? 

Due to the current situation in Canada, all donors are being tested for COVID-19 and screened prior to organ procurement. This process involves screening organ, eye, and tissue donors for risk factors while utilizing approved criteria and testing platforms to ensure accurate results that will determine the next steps for the donations. The screening and testing results are shared with the transplant centres that are accepting the organs, eyes or tissues for transplantation and carefully reviewed prior to transplantation.

What happens if an organ donor tests positive for COVID-19?

Individuals who are donors and have active COVID-19 or have died due to the virus are not eligible to donate their organs. This is due to there being no existing treatment or cure available, which has serious implications for medical staff as well as potential recipients. 

However, if one has recovered from the virus and then passed away from an unrelated cause, a donation is still possible if the organ is a good match. Some of the inclusion criteria involve 28 days passing since recovering from COVID-19, the occurrence of two negative tests, and that no symptoms were present. This is no different than any other disease or illness, but all potential threats are evaluated at the time of death to ensure no trace of disease is passed from donor to recipient. Since deceased donors and potential recipients are being tested for COVID-19, the risk of getting the virus due to the donor organ is minimized.

Does this also impact living organ donations?

Living donors must also be tested for COVID-19. If they have ever had the virus, they will be advised by doctors on what to do moving forward and the doctors will determine whether the individual is  still a candidate for donation after the resolution of symptoms. Any donated organs that test positive for the virus will not be used for transplantation. But it is important to remember there is a very low risk of acquiring COVID-19 from an organ donation.

Are transplant recipients at a higher risk of contracting COVID-19?

There has been no substantial evidence on whether or not transplant recipients experience more serious cases of COVID-19. But it is known that often other viruses have caused more severe disease implications for those who immunosuppressed, such as transplant recipients, so these individuals must follow strict prevention measures for COVID-19. 

A recent study on the outcomes of patients hospitalized with COVID-19 across the United States revealed no differences between patients who were transplant recipients vs. those were not. It was found that their length of stay in ICU, risk of acute respiratory distress syndrome, secondary infection rate, and other clinical outcomes were the same. There was only a slightly higher chance of organ transplant patients dying within 28 days of ICU admission and a history of previous viral infections also led to higher mortality. 

Is organ procurement still taking place during the pandemic? 

For individuals in dire need of a transplant and those at the top of waiting lists, transplants are still taking place. With the ongoing pandemic, there have been many changes to  standard operating procedures in the hospital, which has impacted organ procurement . But yes, organs are being procured and delivered between hospitals with additional safety and screening measures. To ensure this happens, surgeons and essential personnel in healthcare facilities  are complying with the new requirements when caring for donors and recipients. Despite the reallocation of resources to combat the virus, several policy changes have been made at national transplant centres to ensure safe transplantation. 

Conclusion

Overall, the COVID-19 pandemic has negatively impacted organ donation and transplant rates, especially in countries that have a significant number of COVID-19 cases, such as Canada. Although new measures and policies have been put in place at healthcare centres across the country in relation to transplants, the number of transplant surgeries being performed has not recovered to pre-pandemic levels. Hopefully, as the pandemic continues to be controlled, the rates of organ donation and transplantation will return to normal in the near future.

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