Coronavirus in Mumbai: COVID-19 fear takes a toll on kidney transplants
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The impact of the COVID-19 coronavirus pandemic has rippled across all areas of the healthcare system, including organ transplants. There has been a significant decline in renal transplant operations in the city, primarily driven by fears of contracting Covid-19 and the impact on the recipient. As per the Zonal Transplant Coordination Centre (ZTCC), there has been a 74 per cent reduction in kidney transplantation in Mumbai, compared to last year. Doctors and experts have attributed this decrease for lack of awareness about the process, as a result of which demand is low. Besides, they say, these patients have an alternative in the form of dialysis.

Sameer Khanna (name changed), suffering from renal issues for the last five years is on the waitlist. “It has been nearly two years since I have been awaiting a kidney transplant but have yet to find a donor. In 2016, I had kidney issues and ever since, I have been undergoing dialysis twice a week. But in 2018, one of my kidneys was damaged and ever since, I have been waiting for a transplant,” he said.

There are around 3,536 people in the city like Khanna, similarly waitlisted, while 350 are waiting for livers, 27 for hearts, 14 for lungs, 10 for pancreas and three for hands. Data shows that between March and July 2020, only 10 donors have come forward, after which 15 kidney transplants were done, compared to the 59 in the same period last year.

“Demand and supply for kidney transplant is low, so the waiting list is longer. This means recipients have to wait for more than three to four years for their turn,” said an official from ZTCC.

Moreover, the ZTCC and the DHS have set a protocol for hospitals ready to perform organ transplants. Officials said, during the pandemic 38 hospitals had registered for organ transplantation, of which 13 were willing and 18 were not interested, while the remaining were yet to decide.

Dr S K Mathur said, due to the lockdown, there was a significant reduction in the number of transplants. “The programme came to a halt during the nationwide lockdown, which caused doctors to worry about the possibility of SARS-CoV-2 infections being missed in both donors and recipients who were asymptomatic. In the immediate post-operative period and after hospital discharge, recipients have increased susceptibility to SARS-CoV-2 infection owing to induction therapy and immuno-suppressive treatment. This was the reason for patients' reluctance to undergo transplants, particularly kidney transplants, considering the latter have the option of dialysis.”

With proper evaluation of recipient and donor, which includes epidemiologic history, clinical history, throat swab for RT-PCR and HRCT tests and with proper hospital care, kidney transplantation can be performed in the current situation. “It is important to discuss with the patient that despite taking all precautionary measures, a small risk of Covid infection remains, and a dedicated consent form would help patients make well-informed decisions,” said Dr Mathur.

Organ transplant experts, however, said there was a need for more hospitals to register themselves with the state for organ transplantation and retrieval. “In public hospitals, with the bulk of patients, it becomes difficult to identify and counsel families to donate organs of their brain-dead kin. Most are not eligible. They succumb before they can be identified as brain-dead,” said experts.

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