Risk of COVID-19 infection limits kidney transplants to life-or-death cases

To protect fragile patients with failing kidneys from contracting COVID-19, Quebec has suspended all but the most urgent kidney transplant operations.

Directors of transplant programs at hospitals across the province agreed last Thursday it is safer to keep patients on dialysis for a few extra weeks than to perform a transplant and risk possible COVID-19 infection, said Dr. Prosanto Chaudhury, Transplant Qubec's medical director of transplantation.

All transplant recipients require strong medication to suppress their immune systems, so their bodies don't reject the new organ.

"If they do get infected with COVID, they will not be able to fight it in the same way someone with an intact immune system would. At least that's the fear," said Chaudhury.

Until the situation changes, kidney transplants involving both live and deceased donors will not proceed unless a patient will die without the transplant or if that patient is receiving more than one organ, such as heart-kidney, lung-kidney or liver-kidney transplant surgery.

There is no equivalent to dialysis for patients who are waiting for a heart, liver or lungs, so organ donation and transplants for those will continue, Chaudhury said.

He said the suspension of some transplant procedures means some viable organs will not be recovered from deceased donors.

"It's not like we take the organs out and don't use them. It's just there are donations that may not be occurring," said Chaudhury.

Tragic situation

Typically, families consent to donate their loved one's organs after an accident or medical crisis that leaves the patient brain dead. It is an extremely stressful and emotionally trying time, said Chaudhury.

To then find out that their offer can not be accepted at this time is disappointing, he said.

"It's a tragic situation. For every case we have to turn down a donor or a donor family, it's heart-wrenching," said Chaudhury.

"It's equally heart-wrenching knowing that there are some people who could be transplanted and aren't being transplanted right now."

For those families that consent to the donation of other organs, there can be an added stress.

To reduce the transmission of COVID-19, some hospitals are limiting who can enter the hospital.

It will depend on what is happening on the intensive care unit where the donation is taking place, but Chaudhury said visits may be restricted, and family members may not be able to be present at their loved one's bedside.

"[That] is why we thank people even more, because it becomes more difficult to go through that situation if you can't physically be there," said Chaudhury.

Both the donor and the recipient have to be tested for the novel coronavirus before a transplant can proceed.

Depending on the location of a deceased donor, it was initially taking 24 to 48 hours to get the results of that test. This added extra time to the family's grieving process.

But Chaudhury said many hospitals can now do the testing on site, which has reduced the turn-around time to six to eight hours.

Crisis evolving rapidly

As the COVID-19 crisis evolves, Chaudhury said there are ongoing discussions provincially, as well as with their partners across Canada, about how to proceed with transplants safely.

With many hospitals reducing or postponing non-urgent surgeries, Chaudhury, who works at the McGill University Health Centre, said surgeons like himself are being asked to provide their availability when they are not on call for transplants.

However, he is confident that someone from the surgical team will always be available to do urgent transplants.

"The system is still up and running," he said.

"We expect that as this passes, Quebecers will continue their generosity in terms of organ donation, as they have in the past."