Organ donation in the time of COVID-19: the Israeli experience one year into the pandemic—ethical and policy implications

Abstract

Purpose To 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. Methods Data 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. Results Following 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. Conclusion This 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.

Evaluation of organ donation process and affecting factors in COVID-19 pandemic

“…During the pandemic, family interviews were generally conducted by telephone around the world [9]. In a study in Israel, the first family contact was made via telephone for 18% of potential donors, and it was suggested that this negatively affected the donation process [10]. Organ transplant coordinators at our center continued face-to-face meetings, observing preventive measures against infection.…”

“…These rates are lower in Asian countries due to religious beliefs and the rate of practical consent is not well known [11][12][13]. It is clear that innovative technological solutions need to be worked on to increase virtual interactions with family members in times of crisis such as pandemics [10].…”

Evaluation of the Effect of the COVID-19 Pandemic on the Distribution of Kidney Transplants in the World in 2019 and 2020

“…Fewer donors have been admitted to the intensive care unit in Israel, and the number of donor organs has decreased. 8 A group of researchers reviewed transplantation statistics from the World Health Organization website on June 15, 2021. 9 Comparing the average of global kidney transplant statistics between 2010 and 2019 with 2020 statistics, they found a significant decrease in kidney transplants from living donors.…”

Doação de órgãos na pandemia Covid-19: percepção dos profissionais na realização da entrevista familiar

“…Perante a crise mundial, devido a Covid-19, ferramentas virtuais inovadoras foram excepcionais no processo de comunicação sem contato com as famílias. Os aparelhos tecnológicos possibilitaram em meio ao caos dar a oportunidade de acolhimento às famílias e, de não paralisar os serviços (Katvan et al, 2022).…”

“…Houveram diante do momento pandêmico, insatisfações por parte dos familiares, quanto ao acolhimento recebido, fruto de um manejo para a realização da entrevista de improvisação (Santos et al, 2021) As restrições estabelecidas aos serviços de saúde impactaram substancialmente o processo de doação de órgãos e tecidos, tendo em vista, a significativa redução de famílias entrevistadas para a respectiva aceitação. (Katvan et al, 2022).…”