Organ transplants dive into viral crisis and start to recede – Ponoka News

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WASHINGTON – Organ transplants fell when COVID-19 swept through communities, surgeons wary of endangering living donors unable to recover potentially usable organs from the dead – and hospitals sometimes too full even when they could.

Transplants from deceased donors – the most common type – fell by about half in the United States and 90% in France from late February to early April, researchers in the Lancet journal reported on Monday.

Living donor transplants have experienced an equally staggering plunge, according to the United Network for Organ Sharing, which manages the American transplant system. There were 151 living donor transplants in the United States during the second week of March, when a pandemic was declared. There were only 16 such transplants the week of April 5, according to UNOS.

It is too early to know how many people awaiting a vital organ transplant may die not from COVID-19 infection, but because the pandemic has blocked their chances of having a new organ. Kidney transplants account for the vast majority of the decline, but heart, lung and liver transplants have also declined.

Living donations can be reprogrammed, but missed organs from a deceased donor are lost opportunities, wrote Lancet lead author Dr. Alexandre Loupy, kidney specialist who heads the Paris transplant group.

More recent counts by UNOS show that transplants began to decline in late April, as hospitals in the United States tried to decide how to proceed safely.

Geographic variation could offer important lessons, said another study author, Dr. Peter Reese of the University of Pennsylvania.

“The transplant centers and the patients really want to start again, but there are all these questions,” said Reese, whose team is collecting data from Canada and other parts of Europe for further examination. “We need to find places that maintain their transplant rates and find out what they have done.”

Hospitals around the world have postponed all kinds of medical care because they have been inundated with coronavirus patients. Transplants are among the most difficult choices. These are not elective surgeries. But patients must take immunosuppressive drugs to avoid rejection of their new organ – which puts them at increased risk if they come across the virus.

France’s larger drop may be due to more centralized public health policies than state-by-state variations in the United States, said Reese.

“This equation changes depending on the region of the country you are in,” said Dr. Abhinav Humar, transplant chief at the University of Pittsburgh Medical Center. Its transplant center, still in operation, has received patients from New York and other hard-hit areas who needed a new liver, had a living donor and “cannot afford the luxury of waiting at at least two or three months ”in the hope that their original hospital could take them back.

In an average month, New York performs about 220 transplants across the state. In the first weeks of April, which fell to 23, Samantha Delair of the New York Center for Liver Transplantation said during a recent UNOS videoconference.

In contrast, the University of California, San Francisco, in an area less affected by the pandemic, has experienced small declines in transplants, said interim director of transplants, Dr. Chris Freise.

“We are one of the few centers to keep going through it all, but it was not without a lot of thought,” said Freise, who needed daily updates to decide which transplants could be safely planned. – and remains on its guard as California’s restrictions on social separation are gradually lifted.

For example, the Freise team authorized live kidney transplants for people like Herb Hoeptner, who was on the verge of needing dialysis.

“When you have kidneys that have nothing left, you go either on dialysis or you die. It worried me a lot more than the coronavirus, ”said Hoeptner.

The 66-year-old man from Gilroy, California did not realize until after surgery on March 31 how rare a transplant was during the pandemic.

“I was extremely lucky,” added Hoeptner, whose wife, Diane, was his donor and rebounded quickly after the operation.

In places where COVID-19 is most common, living donors are naturally nervous. “We still have no way of talking to living organ donors about what is a reasonable risk,” said Penn’s Reese.

Donations that have died are even more complicated. At first, test shortages made it difficult to certify that potential deceased donors of something unrelated to a car accident were virus-free, a problem that has worsened. However, hospitals do not want out-of-town surgeons to go to recover organs and cannot always spare a local surgeon to do the work or find a plane to fly the organs where they need to go.

Surgeons must weigh whether it makes sense to accept less than perfect organs that could work but could keep the recipient hospitalized longer.

Dr. David Axelrod, kidney surgeon at the University of Iowa, said his team “was trying to be careful about this, trying to make sure that these are organs that we think people can enter and get a successful transplant and get home quickly. ”

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The Associated Press’s Department of Health and Science is supported by the Department of Science Education at the Howard Hughes Medical Institute. The AP is solely responsible for all content.

Lauran Neergaard, The Associated Press

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