The Impact of COVID‐19 on Organ Donation, Procurement, and Liver Transplantation in the United States

Abstract

The coronavirus disease 2019 pandemic has had an impact on all facets of our health care system, including life‐saving procedures like organ transplantation. Concerns for potential exposure to the causative severe acute respiratory syndrome coronavirus type 2 have profoundly altered the process of organ donation and recovery that is vital to the execution of organ transplantation. Issues regarding adequate donor evaluation and consent, organ recovery, organ procurement organization, and donor hospital resources as well as the transplant center’s acceptance of organ offers for their candidates have all required new practice paradigms. 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 expected excellent outcomes for new liver transplant recipients has been challenged during this time. Conclusion: We summarize some of the negative effects of the current pandemic on organ recovery and liver transplantation as well as offer considerations and strategies for their mitigation that could have a lasting impact on the field even after the coronavirus disease 2019 has waned.

COVID-19 and liver disease: mechanistic and clinical perspectives

“…Liver transplantation. Liver transplantation programmes have been affected by the pandemic in a multitude of ways 153,154 . First, the recommendation against using organs from deceased donors with SARS-CoV-2 infection is consistent across all major guidelines 155 .…”

Impact of the COVID-19 pandemic on liver donation and transplantation: A review of the literature

“…For example, early data from Italy – one of the first Western countries dealing with the COVID-19 outbreak – reported a 25% decrease in procured organs during the first month of the outbreak, which paralleled the progressive rise of patients admitted to the intensive care unit (ICU)[ 8 ]. Particularly regarding LT, the United Network for Organ Sharing (UNOS) data revealed a more than 25% decrease between February and April 2020, with an inactivation rate of waitlisted patients between 5%-10%[ 3 ]. This trend is consistent with the 29% decrease registered in the Eurotransplant network in approximately the same period, which inevitably led to increased death and dropout from the waitlist[ 9 ].…”

“…For this reason, some centers have temporarily suspended treating aging patients with comorbidities and surgical complexities to minimize the chance of complications[ 10 , 13 , 14 ]. Likewise, different centers have reduced the use of marginal grafts and those from donation after circulatory death for both fear of poor transplant outcomes and heavier commitment on ICU personnel[ 3 , 15 , 16 ].…”

“…Living donor LT (LDLT) poses additional issues during the pandemic due to the risk of nosocomial transmission to donors as they recover from major surgery. Given the mainly elective nature of the procedure, most programs have considered postponing LDLT an ethically appropriate action during the pandemic peak[ 2 , 3 ]. In April 2020, LDLT activity nearly stopped in Spain[ 4 ].…”

“…During the first pandemic wave, overwhelming hospitals rapidly reallocated their resources and increased their capacity to attend to an exponential increase in the number of critically ill patients, leading to the limitation of oncological and elective surgery[ 1 ]. Organ donation and transplantation have also suffered an inevitable decrease[ 2 , 3 ]. The second pandemic wave in most European countries has posed similar issues regarding resource allocation, although most patients are asymptomatic or present with less severe symptomatology[ 4 ].…”