The impact of COVID‐19 on organ donation and transplantation in the UK: lessons learned from the first year of the pandemic

Abstract

The COVID-19 pandemic had a major impact on UK deceased organ donation and transplantation activity. We used national audit data from NHS Blood and Transplant to explore in detail the effects of the pandemic in comparison with 12 months pre-pandemic, and to consider the impact of the mitigating strategies and challenges placed on ICU by `waves´of patients with COVID-19. Between 11 March 2020 and 10 March 2021, referrals to NHS Blood and Transplant of potential organ donors were initially inversely related to the number of people with COVID-19 undergoing mechanical ventilation in intensive care (incident rate ratio (95%CI) per 1000 patients 0.93 (0.88-0.99), p = 0.018), although this pattern reversed during the second wave (additional incident rate ratio (95% CI) 1.12 (1.05-1.19), p < 0.001). Adjusted numbers of donors (incident rate ratio (95%CI) 0.71 (0.61-0.81), p < 0.001) and organs retrieved (incident rate ratio (95%CI) 0.89 (0.82-0.97), p = 0.007) were inversely dependent on COVID-19 workload, though weekly numbers of transplants were unrelated (incident rate ratio (95%CI) 0.95 (0.86-1.04), p = 0.235). Non-COVID-19 mortality fell from 15,007 to 14,087 during the first wave (rate ratio (95%CI) 0.94 (0.92-0.96), p < 0.001) but climbed from 18,907 to 19,372 during the second wave (rate ratio (95%CI) 1.02 (1.00-1.05), p = 0.018). There were fewer in-hospital deaths from cardiac arrest and intracranial catastrophes throughout (rate ratio (95%CI) 0.83 (0.81-0.86), p < 0.001 and rate ratio (95%CI) 0.88 (0.85-0.91), p < 0.001, respectively). There were overall fewer eligible donors (n = 4282) when compared with pre-pandemic levels (n = 6038); OR (95%CI) 0.58 (0.51-0.66), p < 0.001. The total number of donations during the year fell from 1620 to 1140 (rate ratio (95%CI) 0.70 (0.65-0.76), p < 0.001), but the proportion of eligible donors who proceeded to donation (27%) was unchanged (OR (95%CI) 0.99 (0.91-1.08), p = 0.821). The reduction in donations and transplantation during the pandemic was multifactorial, but these data highlight the impact in the UK of a fall in eligible donors and an inverse relationship of referrals to COVID-19 workload. Despite the challenges faced, the foundations underpinning the UK deceased organ donation programme remained strong.

Post-COVID-19 pandemic organ donation activities in Germany: a multicenter retrospective analysis

“…A COVID-19 infection as a reason against donation was less frequent in 2022, likely because at the end of April 2022, the German Medical Association no longer stated a COVID-19 infection as an absolute contraindication for an organ donation ( 41 ). Additionally, vaccination and protection strategies supported to minimize the effect of COVID-19 on transplantation activities ( 10 ), and resilience throughout the entire ICU, organ donation and transplantation services was improved ( 42 ).…”

“…In this cohort, refused consent was higher in 2021 than 2022. Presumably, fewer restrictions on kin visits, greater resilience to COVID-19, and reduced pandemic-induced uncertainty led to greater ease in obtaining consent in 2022 ( 42 ).…”

“…In fact, Germany had one of the best transplantation responses to the COVID-19 crisis in the early phases of the pandemic ( 14 ). Where transplant activity initially rapidly declined during the first wave of disease, it returned to baseline as the pandemic progressed, despite a higher burden of disease during the second wave ( 42 ). However, the total number of donors per million inhabitants and conversion rates in Germany are traditionally at a low level compared to other countries ( 40 ).…”

“…In other words, it could be speculated that a poor performance was less likely to get worse. Additionally, Germany experienced fewer COVID-19 hospitalizations than other European countries during the first wave resulting in a smaller decline in transplant rates ( 42 ). Other countries also showed a larger decrease in DCD than DBD ( 9 , 42 ).…”

A Single-center Exploration of Attitudes to Deceased Organ Donation Over Time Among Healthcare Staff in Intensive Care

“…Given the dramatic and sustained reduction in deceased organ donation in the United Kingdom caused by the COVID-19 pandemic, 3,10 greater recognition and response to ICU staff attitudes to organ donation is essential. The timing of our surveys was such that ICU staff attitudes after the pandemic were not captured within our data, but this would be a key area of ongoing research both locally and in the wider intensive care community.…”