Managing a Renal Transplant Programme During the COVID-19 Pandemic: Practical Experience from a Singapore Transplant Centre

Abstract

Introduction: Coronavirus Disease 2019 (COVID-19) has significantly affected the way healthcare is delivered in Singapore. Healthcare services such as renal transplantation had to rapidly adjust and meet the needs to (1) protect patients and staff, (2) ramp up, conserve or redeploy resources while (3) ensuring that critical services remained operational. This paper aims to describe the experience of the renal transplant programme at the Singapore General Hospital (SGH) in responding to the risks and constraints posed by the pandemic. Methods and Materials: This is a review and summary of the SGH renal transplant programme’s policy and protocols that were either modified or developed in response to the COVID-19 Pandemic. Results: A multi-pronged approach was adopted to respond to the challenges of COVID-19. These included ensuring business continuity by splitting the transplant team into different locations, adopting video and tele-consults to minimise potential patient exposure to COVID-19, streamlining work processes using electronic forms, ensuring safe paths for patients who needed to come to hospital, ring-fencing and testing new inpatients at risk for COVID-19, enhancing precautionary measures for transplant surgery, ensuring a stable supply chain of immunosuppression, and sustaining patient and staff education programmes via video conferencing. Conclusions: Though the COVID-19 pandemic has reduced access to kidney transplantation, opportunities arose to adopt telemedicine into mainstream transplant practice as well as use electronic platforms to streamline work processes. Screening protocols were established to ensure that transplantation could be performed safely, while webinars reached out to empower patients to take precautions against COVID-19. Keywords: COVID-19, Nephrology, Public Health, Renal Transplant, Transplantation, Urology

Psychological distress and associated factors among kidney transplant recipients and living kidney donors during COVID-19

“…cancer, type 2 diabetes, COVID-19) [ 3 ], and the 39% (clinical anxiety or depression symptoms) among patients with end-stage kidney disease on hemodialysis [ 26 ]. In addition to the effective national responses, the low psychological distress among recipients could also be attributed to the high-quality medical care and intensive follow-ups by the SGH transplant program [ 27 ]. Since the COVID-19 outbreak, the SGH transplant program has adopted a multi-pronged approach to alleviate the impact of the pandemic including rapid transition to video and tele-consults to minimize potential patient exposure to COVID-19, ensuring safe paths for patients who needed to come to hospital, ensuring a stable supply chain of immunosuppression, and sustaining patient and staff education programs via video conferencing [ 27 ].…”

“…In addition to the effective national responses, the low psychological distress among recipients could also be attributed to the high-quality medical care and intensive follow-ups by the SGH transplant program [ 27 ]. Since the COVID-19 outbreak, the SGH transplant program has adopted a multi-pronged approach to alleviate the impact of the pandemic including rapid transition to video and tele-consults to minimize potential patient exposure to COVID-19, ensuring safe paths for patients who needed to come to hospital, ensuring a stable supply chain of immunosuppression, and sustaining patient and staff education programs via video conferencing [ 27 ]. Specifically, two COVID-19 webinars (on May 9th, 2020 and May 30th, 2020) were held to improve COVID-19 knowledge of recipients, in addition to the official social media platform for the kidney recipients which provided a portal for dissemination of electronic education material and peer-support [ 28 , 29 ].…”

Regional Citrate Anticoagulation during Double-Filtration Plasmapheresis in Kidney Transplant Recipients: A Single-Center Retrospective Cohort Study

“…Reduced plasma products use during DFPP may reduce the risk of transfusion-related reactions and the overall cost [2, 28]. DFPP was also helpful in alleviating the national shortage of plasma products during the COVID-19 pandemic [29, 30].…”

Impact of the COVID-19 pandemic on a tertiary care public hospital in Singapore: resources and economic costs

“…Strict limitations were placed on outpatient and elective surgery services [ 14 ]. For patients requiring repeat medications, the hospital’s pharmacy instituted electronic filling of prescriptions with home delivery [ 15 ]. Gradual resumption of outpatient and elective surgeries were allowed when the circuit breaker was lifted – from 1 st June 2020, specialist outpatient visits and medical procedures were first resumed with teleconsultation being the preferred mode of service provision; from 19 th June 2020, screening services and pre-employment check-up were also resumed.…”