Some hospitals around the country are making the difficult decision to postpone kidney transplants in light of the rapidly spreading coronavirus, which threatens to overwhelm our health care system. A list of the leading transplant centers and their current status can be found online.
While this news may be devastating to people who are on the waiting list or have a living donor, it is important to understand the medical reasoning behind the decisions. If you are in this situation, be sure to check in with your transplant center to ask for updates.
1. Hospitals need to ensure that hospital beds and medical staff are available for critically ill patients with COVID-19 — and to limit the potential exposure to the virus by other hospital patients.
The CDC has recommended that elective procedures, surgeries and non-urgent outpatient visits be postponed once the virus has started to spread through a community. The U.S. Department of Health and Human Services is allowing hospitals to treat transplants (as well as vascular access surgeries) as non-elective, and many hospitals are continuing to perform transplants if they are not yet experiencing high numbers of coronavirus infections. Hospitals are making their decisions based on the spread of the virus in their own communities, including among health care workers. Because living-donor kidney transplants require two hospital beds and post-surgical recovery care in the hospital, we are hearing that a growing number of transplant centers are temporarily putting living-donor transplants on hold. This both preserves the availability of hospital beds for emergencies and COVID-19 patients, and also keeps non-infected people out of the hospital.
2. Immunosuppressed people living with transplants are at high risk for serious illness if they come in contact with the coronavirus that causes COVID-19.
The coronavirus spreads easily from person to person, and can be spread by people who do not show symptoms of COVID-19. This puts anyone who has a compromised immune system — including people living with transplants who take immunosuppressive drugs — at an increased risk of becoming infected. Even with social distancing, the virus is still spreading in communities. People with new transplants would be especially vulnerable during their recovery period after transplant surgery. Another obstacle hospitals face is the need to test deceased donors for the coronavirus. Transplanting an organ from a coronavirus-positive patient could present a grave risk to the recipient. With limited test kits needed for living patients, and the lag time between testing and getting results, some hospitals may have to forgo testing — and procuring organs from — deceased donors.
3. Hospitals have a limited number of ventilators available, which could affect their ability to procure organs for transplant from donors who have been declared brain-dead.
Because COVID-19 is a serious respiratory illness, the most critical patients must be put on ventilators. Ventilators are normally used to keep an organ donor alive who is medically brain-dead so that their organs may be removed and transplanted. Those ventilators may be needed for COVID-19 patients instead. We have never experienced anything like this health emergency in our lifetimes. Hospitals are having to make impossible decisions as they balance the risk of death from kidney failure with the infection risk of the coronavirus, and determine how to best use their limited resources during this emergency. While this creates a great deal of uncertainty for people waiting for transplants, we do know that any disruptions are only temporary. If you are on the waiting list or scheduling a living-donor transplant, the most important thing now is to continue your dialysis treatments, stay healthy and do all you can to avoid coming in contact with someone infected with the coronavirus. Read our previous blog post for five urgent reminders for people on dialysis in light of the coronavirus pandemic. You can find more information and resources for people living with kidney disease by visiting our special coronavirus webpage at KidneyFund.org/coronavirus. We will update the page with important information for people living with kidney disease and their caregivers as the coronavirus crisis continues to unfold. Our Coronavirus Emergency Fund is making grants to low-income people living with dialysis and transplants to help them through this health crisis. You can help us help people by making a donation to this emergency fund at KidneyFund.org/emergency — 100% of all donations will be distributed directly to people in need.