Immediate impact of COVID-19 on transplant activity in the Netherlands

Abstract

The rapid emergence of the COVID-19 pandemic is unprecedented and poses an unparalleled obstacle in the sixty-five year history of organ transplantation. Worldwide, the delivery of transplant care is severely challenged by matters concerning - but not limited to - organ procurement, risk of SARS-CoV-2 transmission, screening strategies of donors and recipients, decisions to postpone or proceed with transplantation, the attributable risk of immunosuppression for COVID-19 and entrenched health care resources and capacity. The transplant community is faced with choosing a lesser of two evils: initiating immunosuppression and potentially accepting detrimental outcome when transplant recipients develop COVID-19 versus postponing transplantation and accepting associated waitlist mortality. Notably, prioritization of health care services for COVID-19 care raises concerns about allocation of resources to deliver care for transplant patients who might otherwise have excellent 1-year and 10-year survival rates. Children and young adults with end-stage organ disease in particular seem more disadvantaged by withholding transplantation because of capacity issues than from medical consequences of SARS-CoV-2. This report details the nationwide response of the Dutch transplant community to these issues and the immediate consequences for transplant activity. Worrisome, there was a significant decrease in organ donation numbers affecting all organ transplant services. In addition, there was a detrimental effect on transplantation numbers in children with end-organ failure. Ongoing efforts focus on mitigation of not only primary but also secondary harm of the pandemic and to find right definitions and momentum to restore the transplant programs.

Keywords: COVID-19; Outbreak; SARS-CoV-2; Transplant programs; Transplantation.

Fig. 1

Impact of the COVID-19 outbreak on organ donation and transplant activity in the Netherlands. Depicted is the number of donors and transplants performed over the last year per month in the Netherlands. The month when the pandemic was unfolding includes the dates 15 March 2020–15 April 2020. A) Living donors are shown in light grey and post-mortem donors in dark grey. B) the number of total organ transplants, C) pancreas transplants D) renal transplants from living (grey) and post-mortem donors (black), E) liver transplants, F) lung transplants G) heart transplants and H) the total number of pediatric transplantations (age 0–16 years).

Fig. 2

Impact of the COVID-19 outbreak on the liver transplant waiting list and kidney waiting list outflow in the Netherlands. A) the number transplantable (T) and non-transplantable (NT) patients on the waiting list for a liver transplantation in the Netherlands over the last year. B) the number of end stage renal disease patients taken of the renal transplant waiting list due to death or deterioration of the disease (black bars) or due to other reasons (grey bars) in the Netherlands over the last year. Other reasons include on hold (5), medical contra indication (3), too good for transplantation (19), moved abroad (1), patient doesn't want to be transplanted anymore (3), no reason mentioned (2).