The COVID-19 pandemic has slowed down organ transplants in Tamil Nadu. Though a few hospitals continued to perform living donor kidney and liver transplants throughout the pandemic, some of the major hospitals — especially in the government sector — had to push back transplantations after being flooded with COVID-19 cases.
Though resumption of services is on the cards, the pandemic has brought along a set of challenges for transplant teams. Patient safety is a key priority.
Officials said the deceased donor transplant programme was slowly picking up. “Soon after the lockdown in March last year, the programme came to a standstill in April for want of protocols. Transplant services resumed in May after protocols were drafted but there were fewer donors owing to the lockdown...,” an official said.
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Last year, there were 55 deceased donors. So far this year, there have been 28. While a total of 236 organs were utilised last year, 133 organs were utilised this year, according to data from the Transplant Authority of Tamil Nadu.
Utilisation rate
Though there were fewer donors, officials said the organ utilisation rate was “good”. “Kidney utilisation during April 2020-March 2021 was 84%. The remaining 16% could not be utilised owing to the medical conditions of the donor kidneys. During the same period, 90% of the livers were utilised. The remaining 10% were not utilised owing to their being fatty and other medical conditions,” the official said.
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As many as 500 living donor kidney transplants and 222 liver transplants were performed from January to December 2020.
This year, 394 living donor renal transplants were performed during the period from January to June. During the same period, 191 living donor liver transplants were done.
The challenges are numerous, transplant surgeons said. A surgeon in the government sector said they did very few living donor transplants in 2020 and so far this year, with COVID-19 disrupting the services. Cadaver transplants were almost nil.
In some instances, patients did not opt for transplants knowing the risks involved in a pandemic situation. “Some patients suffering from chronic kidney diseases preferred to continue on dialysis rather than take the risk and develop COVID-19 as there is a high chance of contracting the infection in the post-operative period,” the official said.
After the entire medical services were focused on COVID-19 care for over a year now, some hospitals in the city are planning to re-start the transplant programmes soon.
“We are planning to resume them next week. But there are huge challenges and we cannot afford to do it in a hurry. Patients who undergo organ transplants are on immunosuppressant drugs — high dosage especially in the first few months — to prevent rejection. In such circumstances, if they contract COVID-19, we will be forced to reduce the immunosuppressants that will result in organ rejection,” said N. Gopalakrishnan, director, Institute of Nephrology, Rajiv Gandhi Government General Hospital.
Total vaccination
While patients are managing with dialysis, the emphasis is on getting them fully vaccinated. “We are telling patients coming to the outpatient departments and on dialysis to get vaccinated at the earliest. It is ideal that they receive both doses before going in for transplant,” he said.
While the conflict of immunological challenges and COVID-19 challenges remain, there is another fear factor.
“Transplant recipients who contract COVID-19 face yet another challenge — mucormycosis — which would warrant withdrawal/down- titration of immunosuppressives,” Mr. Gopalakrishnan added.
Raja Mahesh, nephrologist and transplant surgeon, Apollo Hospitals, said the hospital opted not to go ahead with transplants because if patients on immunosuppresants were infected with COVID-19, the outcome was not good.
He added that patients with chronic kidney diseases could sustain life on dialysis, and required transplants for better quality of life. “We did one or two transplants for patients who could not be managed on dialysis,” he said.
“The overall number of deceased donor transplants has come down. We did a few living donor renal transplants between the two waves. It started to pick up slowly but we had to stop owing to the rise in infections in the second wave,” he said.
Except for emergencies, patients were asked not to come for routine hospital visits and were managed by and large over the phone. “There are a lot of issues. We avoided admitting patients in hospitals as the risk of contracting infection within any hospital set-up is high,” he said.
The wait-list has built up in the last one-and-a-half years, he said, adding that Apollo Hospitals was planning to re-start transplant services soon.