Co – Authored by Dr Swapnil Sharma, Consultant-Liver Transplant & HPB Surgery, Fortis Hospital, Mulund & Dr Atul Ingale, Senior Consultant Nephrologist & Transplant Physician, Fortis Hiranandani Hospital, Vashi
The coronavirus pandemic for the past 17 months has had an impact on all facets of our healthcare system, including life-saving surgeries like organ transplantation. Fear about potential exposure to infection and the subsequent complications related to COVID19 have profoundly altered the process of organ donation that is vital to the execution of organ transplantation. Especially, cadaver donation has seen a major drop due to various reasons – one being the ICU departments were filled with COVID19 patients and so the donation rate was very less. Similarly, in the cases of live donors, fear was such that people weren’t willing to go to hospitals and were delaying elective surgeries & organ transplantation. Most hospitals in India have faced severe challenges regarding adequate cadaveric organ donations and live donations that aid Liver and Kidney transplantation.
Consequently, the ability to treat patients with organ failure, in particular patients with end-stage Liver disease in whom no temporizing treatments exist, and to obtain favorable outcomes for new Liver transplant recipients, has been challenged during this time.
WHY ORGAN DONATION IS MOST RELEVANT AND NECESSARY IN TODAY’S TIMES? End-stage organ failure is estimated to affect more than 4 to 6 million people worldwide. India’s organ donation rate is the lowest in the world. India’s organ donation rate (ODR) stands at an alarming 0.34 per million population (PMP) when compared with donation rate of 36 PMP in countries like Spain. As per NOTTO, around 5 lakh people in India need organ donation every year. Many patients die due to the lack of availability of donors for transplants. 17 people die each day waiting for an organ transplant in the country. The pandemic added to these issues. One concern was that transplant recipients may have a greater susceptibility to infection and greater viral burden. A second concern was that many hospitals in the country lacked resources in terms of staff and equipment to care for recipients after transplantation, who often require intensive care & multispecialty management. Because of the overwhelming burden on the healthcare system, a dramatic negative effect on nationwide organ donation and transplantation was experienced.
HOW THE PANDEMIC CHANGED THE ORGAN DONATION AND TRANSPLANT SCENARIO? The pandemic has led to several changes in processes for donor hospital resources as well as the transplant center’s acceptance of organ. To adapt to the new normal, new protocols involve processes to be followed by hospitals before organ transplantations, during, and after transplants in order to protect the recipients and donors.
Donor history and COVID19 testing have become a routine part of the process of donor evaluation today. All donors must undergo screening for COVID19. Astute history taking, obtaining chest imaging, and performing microbiologic testing has become essential. In all cases the decision to proceed for a transplantation is considered depending on the urgency of the transplant and the risk & benefits to both donor and recipient. Similarly, all potential organ transplant recipients are screened for COVID19 through history taking, chest imaging, and microbiologic testing prior to transplantation. Therefore, despite the pandemic if we take all the precautions, donor and patients can be protected against COVID and transplantations can be performed safely.
VACCINATION IS IMPORTANT FOR RECIPIENTS AND DONORS: There is a need to improve organ donation to restore normalcy in transplant services. Vaccination is one way to do so.All transplant recipients are eligible for vaccination, unless contraindicated (eg: Hypersensitivity to the vaccine or its components). Although the immunogenicity and efficacy of COVID19 vaccines are uncertain in solid organ transplant recipients, the potential for benefit from vaccination likely outweighs this uncertainty. Organ transplant recipients should continue to adhere to protective measures (such as masking and social distancing) despite vaccination, based upon data suggesting suboptimal immune response among transplant recipients.
Also, If India’s donation rates were to be improved to one donation per million deaths, it would save so many lives. The process of pledging is simple. A donor card is provided to a person who is willing to donate their organs and tissues after death. Donor cards are not a legally binding document – it is only an expression of a person’s willingness to be a donor. At the time of organ donation, the family of the patient will make the final decision on whether to donate organs or not. Any person willing to donate his/her organs can do so by filling out the donor consent form available on the Ministry of Health and Family Welfare, Government of India website. One can also speak to your healthcare providers about organ donation to understand its relevance.