Immediate impact of COVID-19 on transplant activity in the Netherlands

Abstract

The rapid emergence of the COVID-19 pandemic is unprecedented and poses an unparalleled obstacle in the sixty-five year history of organ transplantation. Worldwide, the delivery of transplant care is severely challenged by matters concerning-but not limited to-organ procurement, risk of SARS-CoV-2 transmission, screening strategies of donors and recipients, decisions to postpone or proceed with transplantation, the attributable risk of immunosuppression for COVID-19 and entrenched health care resources and capacity. The transplant community is faced with choosing a lesser of two evils: initiating immunosuppression and potentially accepting detrimental outcome when transplant recipients develop COVID-19 versus postponing transplantation and accepting associated waitlist mortality. Notably, prioritization of health care services for COVID-19 care raises concerns about allocation of resources to deliver care for transplant patients who might otherwise have excellent 1-year and 10-year survival rates. Children and young adults with end-stage organ disease in particular seem more disadvantaged by withholding transplantation because of capacity issues than from medical consequences of SARS-CoV-2. This report details the nationwide response of the Dutch transplant community to these issues and the immediate consequences for transplant activity. Worrisome, there was a significant decrease in organ donation numbers affecting all organ transplant services. In addition, there was a detrimental effect on transplantation numbers in children with end-organ failure. Ongoing efforts focus on mitigation of not only primary but also secondary harm of the pandemic and to find right definitions and momentum to restore the transplant programs.

Organ donation during the COVID-19 pandemic

“…Most existing studies on transplantation and COVID‐19 have approached recipient related issues and medication challenges at a transplant center‐level, however, little is known about the impact on OPOs and the donor service. It may be that existing social distancing measures and health policy recommendations play a role in their functionality and, on the basis of previous observations in the surgical literature, we hypothesized that the current COVID‐19 crisis may have affected donor volume, organ yield, and service activity 12‐14 . One important question to ask is how this pandemic has altered the process of organ donation and how long it could take to address a potentially growing waiting list.…”

Suspension and resumption of kidney transplant programmes during the COVID‐19 pandemic: perspectives from patients, caregivers and potential living donors – a qualitative study

“…The COVID-19 pandemic has impacted on kidney transplant programmes globally [1][2][3][4]. Many countries have restricted or suspended kidney transplantation programmes due to concerns for patient safety and the shortage of healthcare resources during the pandemic [2,[4][5][6][7][8][9]. There are some data to suggest that kidney transplant recipients are at an increased risk of severe COVID-19 because of immunosuppression and comorbid conditions [7,[10][11][12][13].…”

Donación y trasplante de órganos en medio de la pandemia COVID-19: Consecuencias y retos para un país emergente

“…[6][7][8] Impacto de la Pandemia COVID-19 en la Donación y Trasplantes: Experiencias Internacionales Durante el inicio de la pandemia por COVID-19 en Holanda se registró un descenso del 67% en el número total de trasplantes ejecutados y se suspendió la actividad de donante vivo. 9 En Italia durante las primeras cuatro semanas de la pandemia, se registró un descenso entre el 25% y el 30% del total de extracciones de órganos para trasplante provenientes de donantes cadavéricos. 10 España, uno de los países más afectados por la pandemia COVID-19, presentó un descenso cercano al 84% en la actividad de donación cadavérica y en el número de trasplantes ejecutados tras la declaración de estado de alarma nacional así como el cierre de la actividad de donación de vivo, 11 allí el promedio de donantes cadavéricos y trasplantes ejecutados pasó de 7,2/día y 16,1/día respectivamente a 1,2/día y 2,1/día durante el periodo de estado de alarma nacional.…”