Survey of US Living Kidney Donation and Transplantation Practices in the COVID-19 Era

Abstract

Introduction: The scope of the impact of the coronavirus disease 2019 (COVID-19) pandemic on living donor kidney transplantation (LDKT) practices is not well defined.

Methods: We surveyed US transplant programs to assess practices, strategies, and barriers to living LDKT during the COVID-19 pandemic. After institutional review board approval, the survey was distributed from 9 May 2020 to 30 May 2020 by e-mail and postings to professional society list-servs. Responses were stratified based on state COVID-19 cumulative incidence levels.

Results: Staff at 118 unique centers responded, representing 61% of US living donor recovery programs and 75% of LKDT volume in the prepandemic year. Overall, 66% reported that LDKT surgery was on hold (81% in "high" vs. 49% in "low" COVID-19 cumulative incidence states). A total of 36% reported that evaluation of new donor candidates had paused, 27% reported that evaluations were very much decreased (>0% to <25% typical), and 23% reported that evaluations were moderately decreased (25% to <50% typical). Barriers to LDKT surgery included program concerns for donor (85%) and recipient (75%) safety, patient concerns (56%), elective case restrictions (47%), and hospital administrative restrictions (48%). Programs with higher local COVID-19 cumulative incidence reported more barriers related to staff and resource diversion. Most centers continuing donor evaluations used remote strategies (video, 82%; telephone, 43%). As LDKT resumes, all programs will screen for COVID-19, although timeframe and modalities will vary. Recommendations for presurgical self-quarantine are also variable.

Conclusion: The COVID-19 pandemic has had broad impacts on LDKT practice. Ongoing research and consensus building are needed to reduce barriers, to guide optimal practices, and to support safe restoration of LDKT across centers.

Keywords: COVID-19; kidney transplantation; living kidney donation; pandemic; screening; telehealth.

Figure 1

Barriers to living donor candidate evaluation related to the pandemic, by state coronavirus disease 2019 (COVID-19) cumulative incidence level. States were categorized into 3 levels providing approximately equivalent number of centers in each, based on cases/100,000 (14 May 2020) as: low, up to 200 cases per 100,000; moderate, 200 to <500 cases per 100,000; and high, ≥500 cases per 100,000. Although the sample size of programs was too small for statistical significance (P > 0.05 by χ² test), stratification by local COVID-19 cumulative incidence is presented to assess trends in the relationship of local disease burden with living donor care practices.

Figure 2

Volume of living donor kidney transplantation (LDKT) activity during the pandemic, by state coronavirus disease 2019 (COVID-19) cumulative incidence level.

Figure 3

Barriers to living donor transplant encountered related to the pandemic, by state coronavirus disease 2019 (COVID-19) cumulative incidence level. OR, operating room.

Figure 4

Barriers to living donor follow-up encountered related to the pandemic, by state coronavirus disease 2019 (COVID-19) cumulative incidence level. lab, laboratory.