The coronavirus pandemic has adversely hit organ transplants in the state, with zero cadaver donations and just three live organ transplants recorded in April. A disruption in these donations has meant a longer wait list for patients requiring organ transplants.
“It is a point of crisis. Live donations have halted, so have cadaver donations,” said Astrid Lobo, director of Regional Organ and Tissue Transplant Organisation (western region).
From March 22 to April 18, there were six live and cadaver kidney donations in the state, as compared to 71 recorded between February 21 and March 21. The total live and cadaver liver donations, too, came down to just three after the lockdown was imposed, from 21 recorded in the one-month period preceding it. The nationwide lockdown was imposed on March 24.
In contrast, in March alone, 72 new patients registered for a kidney transplant, while 67 registered for liver, five for heart, one each for lung and pancreas. The number of patients in wait list for organs in Maharashtra stands at 5,757 for kidney, 1,137 for liver, 73 for heart, 14 for lung, 45 for pancreas and three for small bowel.
The National Organ and Tissue Transplant Organisation (NOTTO) is in the process to prepare guidelines for hospitals to conduct transplants. Currently, NOTTO has issued guidelines advising temporary suspension of cadaver and elective transplants to “prevent community transmission of virus”.
Data from the state government shows that in February there were 35 live kidney and liver transplants, which means a single kidney or a part of liver was harvested and transplanted from a living person to another person. The same month there were 12 cadaver organ transplants, which are organs harvested from a brain-dead person.
In March, when the outbreak began, the count of live organ transplants dipped to 22 and cadaver donations to five in the state. In April, only three live donations — two kidney and one liver – were recorded in the entire state.
While emergency, life-saving surgeries are being performed at hospitals, organ transplants are avoided because fewer donors available, and surgeons do not want to take the risk of exposure. A transplant requires cutting open a body to harvest an organ and transplant them into another person. This puts a doctor at a greater risk of exposure in cases where a patient is infected. It also puts the patient at increased infection risk, as transplant lowers their immunity. To delay transplants, kidney patients are being put on dialysis support, but those requiring liver, heart and lung transplants can only rely on medication for a few days.
At Jupiter Hospital, which has a wait list of more than 1,500 patients requiring kidney and more than 70 requiring liver, transplant procedures have been put on hold due to infection risk. “The operation theatre has 10-15 surgeons together at once, so social distancing is difficult. The immunity of patient also goes down post a transplant, and there is greater risk of infection,” a transplant co-ordinator from the hospital said. The official added that with a dip in road accidents, number of head injury cases, and subsequently brain-dead patients, have also come down, which has also affected cadaver donations.
Dr Ankur Garg, a liver transplant surgeon at Nanavati hospital, however, said, “It is not that brain stem deaths are not happening at all, but somehow with COVID-19 as an immediate crisis, focus has come down on brain death declaration and cadaver donation… The risk of not doing emergency surgery is far greater, vis-a-vis, risk of exposure to coronavirus in critical transplant patients.”
The last transplant in state was performed at Nanavati hospital last week under Dr Garg on a patient with acute and chronic liver failure. The man’s son had donated a part of his liver. “The patient was in ICU for last three weeks. Because of a liver failure, his other organs were getting affected. We conducted a COVID-19 test on both the donor and the recipient before the transplant. No visitor, except the patient’s wife, was allowed to meet recipient in the isolation room thereafter. The hospital staff was strictly screened every day,” Garg said.
Four to five other liver failure patients, who have completed paper works and legal formalities, and also obtained consent of donors, are waiting for a transplant at Nanavati hospital. However, their procedures have been on hold due to the coronavirus outbreak. All these patients, doctors said, are being currently being clinically managed, and transplants will be undertaken once the outbreak subsides.
Surgeons said there is a risk of aerosols when a body is cut open during a transplant. It puts the surgeon at risk of exposure to the virus, if COVID-19 status is unknown of the cadaver donor or recipient.
Ganesh Sanap, from Apex Swap Transplant Registry, said, “There is fear on both sides. Patients fear going to hospitals because they think they may get coronavirus infection. Surgeons are scared to perform a surgery because they can be exposed too.” He added that for kidney patients, dialysis is the only option at present. “But there is infection risk there too. Four days ago, six to seven patients tested positive after dialysis in Mumbai,” Sanap said.