Abstract
PurposeTo present the response of the Israel National Transplantation Center (NTC) to the evolving challenge of COVID-19, the impact on deceased organ donation and living organ kidney donation during 2020, and resultant policy and ethical implications.MethodsData collected included (i) for deceased donors, the total number of potential organ donors, if hospitalized in ICU or general ward, cause of death, number of family authorizations and refusals, number of actual donors, number of organs transplanted/donor and total number of transplants performed; (ii) for living-kidney-donors (related or altruistic), the number of procedures performed; and (iii) the number of patients registered on the national organ waiting-list.ResultsFollowing the first case (February 2020), deceased organ donation continued uninterrupted. The total number of potential donors was similar to 2019 (181 vs. 189). However, the number of families approached for donation decreased significantly (P = 0.02). This may be attributed to COVID-19-imposed limitations including fewer brain death determinations due to limited possibilities for face-to-face donor coordinator-donor family interactions providing emotional support and visual explanations of the medical situation. Fewer donors were admitted to ICU (P = 0.1) and the number of organs retrieved/donor decreased (3.8/donor to 3.4/donor). The overall result was a decrease of 24.2% in the number of transplant procedures (306 vs. 232). Living kidney donation, initially halted, resumed in May and the total number of procedures increased compared to 2019 due to a significant increase in altruistic donations (P < 0.0001), while the number of related-living donations decreased.ConclusionThis study of organ donation during a crisis has informed the introduction of policy changes in the NTC including the necessity to mobilize rapidly a “war room”, the use of innovative virtual tools for contact-less communication, and the importance of cooperation with hospital authorities in allocating scarce health-care resources. Finally, the pandemic highlighted and intensified ethical considerations, such as under what circumstances living kidney donation be continued in the face of uncertainty, and what information to provide to altruistic donors regarding a prospective recipient, in particular whether all options for related living donation have been exhausted. These should be addressed now.
Highlights
Coronavirus disease 2019 (COVID-19) is a contagious illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
The steering committee of the National Transplantation Center (NTC) in Israel reached a unanimous decision at the onset of the outbreak in Israel, the first case being confirmed on 21 February 2020, that the organ donation program should continue without interruption, since organ donation is considered a life-saving procedure for many patients with end-organ disease
In this article we describe the changes in NTC policies during the crisis, the actions which the Center implemented in order to optimize results in a reality of rapid changes and the effect of the pandemic on organ donation in Israel
Summary
Coronavirus disease 2019 (COVID-19) is a contagious illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Initial data from China found that 19% of infected patients required hospitalization while experience from the most severely affected countries, such as Italy, revealed that 3.2% of their patients required admission to intensive care units (ICU) to manage the respiratory consequences of the COVID-19 [1, 2]. It became apparent that the availability of hospital beds, in particular ICU beds, would become crucial to treat effectively those most severely affected by the virus Both potential organ donors and organ recipients are routinely managed in an ICU. It was recognized that there were significant concerns relating to this decision which needed to be addressed These related in particular to protecting both recipients from acquiring the disease via transmission of the virus from infected donors and health care workers involved in the donation process
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