Nevada RNformation - March 2011

Page 20 • Nevada RNformation March, April, May 2021
The Effects of COVID-19 on Organ Donation and Transplantation
John A. Lilley, MBA, BSN, RN, CPTC
Vice President of Organ Operations
DonorNetworkwest.org
In December 2020, the
Merriam-Webster English
Dictionary announced
“pandemic” as the word of the
year due to its increased use
and investigation of meaning.
At the same time, Dictionary.
com announced the People’s
Choice 2020 Word of the Year
to be “unprecedented.” The
site’s Senior Research Editor, John
Kelly, described the use of unprecedented in the form of
“...the pandemic, the protests, the presidential election,
the extreme climate episodes – 2020 sent us searching for
a word that could do justice to the scale and pace of all
this upheaval” (Minegar, 2020). For those of us in health
care, unprecedented in 2020 meant the added daily stress
in witness of suffering and death from COVID-19, the
emphasis and availability of personal protective equipment
to safeguard the provider, patient, and community, along
with navigating the use of precious resources to maintain
quality for as many patients as possible.
For professionals working in organ donation for
transplantation, unprecedented is also a word that
was commonly used during the tumultuous year of
2020 and over the last several years. As a community
of Organ Procurement Organizations (OPO), transplant
centers, and donor hospitals where a potential donor is
identified, the number of deceased organ donors has
experienced unprecedented growth in the last decade.
Since 2011, there has been a 54.9% (4,463) growth in
the number of recovered donors in the United States.
During the year of the SARS-CoV-2 pandemic, there
was a 6.1% (718) growth of recovered deceased donors
compared to 2019 (U.S. Department of Health & Human
Services, 2021). This increase in deceased donors
equated to more transplants. Since 2011, there has
been an increase in transplants from deceased donors
by 47.8% (10,778) and a growth from 2019 of 3.1%
(987). Considering the pandemic’s effect on donation
and transplantation, one can call these increases
unprecedented in the number of lives impacted and
saved through the incredible gift of organ donation (U.S.
Department of Health & Human Services, 2021).
Nevertheless, there was also a discouraging change
in transplantation in 2020 due to COVID-19. In March
2020, out of the uncertainty of the effects of the virus
and concern for patients, along with centers focusing
their resources on emergent needs, 72% of transplant
centers in the U.S. suspended their living-donor
transplant programs (Boyarski, et al., 2020). Considered
“non-essential” elective medical procedures, kidney
transplants, especially from living donors, were placed
on hold. In a letter to the Department of Health and
Human Services (HHS) in March 2020, the National
Kidney Foundation urged centers and specifically
HHS to stress the importance of defining “nonessential”
procedures that included access to kidney
transplantation. “The National Kidney Foundation
urged the Administration to distinguish which
procedures are truly elective and non-essential from
procedures – like organ recovery and kidney transplant
– that have immediate, significant, and life-long
benefits for patients. These delays and barriers would
effectively preclude most life-saving kidney transplants
for the near term” (National Kidney Foundation,
2020). Overall, for 2020, national living donation
and transplant rates declined by 22.4% (1,655) in
comparison to the previous year (U.S. Department of
Health & Human Services, 2021).
There are currently over 108,000 candidates in
the U.S. waiting for a solid organ transplant (Organ
Procurement & Transplant Network, 2021). The vast
majority (84.5%) of these patients hope for a kidney
from the generous gift of either a living or deceased
donor. Others are looking forward to a new heart,
lungs, liver, pancreas, or intestine to save, heal, and
enhance their life. In Nevada, over 600 patients are
hoping for a transplant.
Nevada has also seen unprecedented growth in
donation and transplantation. Since 2011, the number
of deceased donors from Nevada residents has
increased an extraordinary 206.2% (134), resulting in
thousands of transplants across the country, including
over 500 Nevadans (U.S. Department of Health &
Human Services, 2021). In 2020, twenty additional
deceased organ donors from the previous record year
represented an 11.2% increase (U.S. Department of
Health & Human Services, 2021). These are remarkable
accomplishments.
Unfortunately, there are still too many deaths for
those who require a solid organ transplant in the U.S.
and Nevada. On average, 17 people die every day waiting
for a transplant, and another person is added to the
national waitlist every nine minutes (Health Resources &
Services Administration, 2020). Although these numbers
do not compare to our experiences of death during the
COVID-19 pandemic, they have been consistent year over
year, resulting in tens of thousands of deaths.
With the world realizing a death toll from the SARS-
CoV-2 virus projected at close to three million and the
U.S. over 550,000 by May 1, 2021 (Institute of Health
Metrics and Evaluation, 2021), we find ourselves
focused on another phrase. What is our “new normal”
going to be in 2021 and beyond? Many of us have a
current “normal” allowing us to go to restaurants that
are restricted to a lower than standard capacity. We
have access to grocery stores and our favorite big box
store. Moreover, we can enjoy the relative freedom to
move about while following mask-wearing guidelines,
social distancing, and avoiding crowds outlined by the
Centers for Disease Control and our state government.
Our “normal” is very different from those in our nation
and state awaiting a solid organ transplant. The impact
of COVID-19 on donation and transplantation in the
U.S. has yet to be fully realized. The initial examination
has shown a probable loss of life of those on the
waiting list due to the virus’s overall impact. Additional
research is needed. All healthcare entities involved in
providing transplants are focused on improvement.
Also, upcoming governmental changes are pushing for
increasing the recovery and transplant of organs.
In July 2019, the “Advancing American Kidney Health”
presidential executive order was enacted, promoting
several goals in improving kidney health, including
doubling the number of kidneys available for transplant by
2030. This order put in motion an extensive governmental
review of the country’s 58 OPOs. The review included
what measures and how all not-for-profit OPOs are
evaluated and certified. In November 2020, this evaluation
led to the Centers for Medicare and Medicaid Services
(CMS) updating guidelines and conditions for coverage
for OPOs. The new measures are designed to “…improve
the quality of OPO services and hold underperformers
accountable” (CMS, 2020). OPOs will be focused on
meeting overall donation rates and transplantation rates,
with the new proposal estimating the addition of 8000
annual transplants. These measures include a higher
level of transparency using reliable data to evaluate
each procurement agency and place requirements for
quality assurance and performance improvement on
underperforming OPOs. These changes continue to
focus all OPOs on providing as many organs as possible
to reduce the suffering and deaths of those experiencing
end-stage organ failure. However, OPOs cannot do this
alone.
OPOs are reliant upon hospital partners to identify
and refer all possible donor candidates. State and
federal statutes outline the need for hospitals to refer
patients promptly to their affiliated OPO. Studies show
that there must be “…a universal understanding that
timely referrals provide both the organ procurement
and the bedside teams with the time they need
to optimally support the family while preserving
their opportunity to donate” (Wojda, et al., 2017).
Allowing time for OPOs to mobilize their resources for
collaborative evaluation, determination of suitability,
and families’ interactions is crucial for increasing the
number of available organs to waiting recipients.
With OPOs and donor hospitals doing everything
they can to ensure organ availability, transplant centers
should be driven to ensure every healthy and safe organ
is implanted. In March 2021, new guidelines outlined
by the U.S. Public Health Service (PHS) for assessing
donors and recipients for HIV, Hepatitis B virus, and
Hepatitis C virus will be implemented. The guidelines
remove the term “increased risk” from donors who have
previously been classified as posing a possible higher
risk of transmitting these viruses through a solid organ
transplant. Since 2013, this label is thought to have led
to the discard of hundreds of organs annually (Volk,
Wilk, Wolfe, & Kaul, 2017). The dramatic improvement
in evaluation and testing in the last several decades for
potential organ donors has led to the PHS changes for
risk assessment in hopes that more organs will help
waiting recipients (Jones et al., 2020).
Patients waiting for a transplant who were already
facing daily challenges of managing chronic and acute
demands of living with organ failure such as dialysis,
ventricular assist devices, oxygen therapy, and frequent
lab and medical assessments did not decrease in 2020
during the COVID-19 pandemic. With over 91,000
patients on the national kidney waiting list, the majority
of whom receive maintenance dialysis, merely managing
the exposure of COVID-19 while trying to provide safe
transplants for these vulnerable patients has been
challenging. COVID-19 has affected potential recipient
patients around the country and here in our local
communities within Nevada. The precious gifts from
deceased and living donors continue to trend upward, but
we, as a collective of donor hospitals, transplant centers,
and OPOs, have an obligation to those waiting recipients
that most of us will never meet. Are you doing your part?
References
Boyarski, B. J., Werbel, W. A., Durand, C. M., Avery, R.
K., Jackson, K. R., Kernodle, A. B., . .. Massie, A. B.
(2020). Early national and center-level changes to
kidney transplantation in the United States during
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Centers for Medicare & Medicaid Services. (2020, November
20). CMS finalizes policy that will increase the number of
available lifesavings organs by holding organ procurement
organizations accountable through transparency and
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first%20new%20measure%20is,an%20organ%20
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