New Delhi, Aug 13 : The nationwide lockdown imposed from March 24 has affected services across sectors, and key areas of medical care were also not left untouched due to the 68-day total shutdown.
In the grip of the coronavirus and lockdown, the life-saving organ transplant procedures had come to a standstill. The hospitals and transplantation centers have experienced a tremendous reduction in the number of organ donations and solid organ (kidney, liver, heart, and lung) transplant procedures, leading to an exponential rise in the deaths of patients who were waiting for critical transplants.
Doctors have estimated that they lost at least thrice the number of patients during lockdown than in normal times due to “waitlist mortality”.
“This is a heart-shattering fact. We have observed a lot of waitlist mortality during the lockdown. The people who expected transplantation have passed away just waiting for their surgery,” said Ushast Dhir, a surgeon in liver transplantation and gastroenterology at Sir Ganga Ram Hospital in New Delhi.
Dhir said that many patients have died during the lockdown. While it is challenging to assess nationwide figures in the absence of any register, he estimated that his hospital lost patients on the waitlist three times more during the lockdown than normal times.
However, multiple factors like stricter norms due to the Covid-19 pandemic, unavailability of donors, restriction on mobility in lockdown, and the fear of Covid among living donors and the patients, have also played a role in the delayed transplantation that eventually led to the deaths.
No accidents, no organs for transplantation
The doctors said that the primary reason behind the extended wait was the unavailability of organs. The live donors and the patients were hesitant to undergo transplant surgery due to the Covid scare. Meanwhile, the patients who did not have living donors, but needed surgery immediately, were unable to find deceased donors in the lockdown period.
“The majority of the deceased donors come from cases of road accidents. Since vehicles were not plying on the roads during the lockdown, it prevented accident deaths, leading to a huge scarcity of organs for critically-ill patients,” said Harish Manian, CEO of MGM Hospital in Chennai.
Manian also agreed with Dhir that the waitlist mortality was nearly thrice than the pre-lockdown period. “We do not have any exact figures since it is not published anywhere. However, observing the trend, this estimate does not seem like an exaggeration,” he added.
Unreachability to transplantation centres
Pradeep Joshi, who was GI and liver transplant surgeon at the King George Medical College (KGMC) in Lucknow, said that many patients, especially in small towns, would have suffered as they could not have accessed the transplantation centers during the lockdown as they are based in metro and bigger cities.
“The need for transplant is an indication that the patient is at the end-stage. The survival in this condition is up to 6 months, and such terminally-ill patients, who needed transplantation during the lockdown, were unable to get it due to restriction on mobility. Not everyone could afford an air ambulance,” he said.
Stricter norms after the onset of Covid
Apart from immobility and scarcity of donors, another factor that contributed to the waitlist mortality was stricter norms in organ transplantation enforced in view of Covid-19. The doctors opined that these norms had led to a substantial drop in deceased organ donation and transplantation.
As per the latest guidelines, the donor, the recipient, and the close relatives of both have to obtain negative status in the Covid-19 test, before the transplantation process.
Time is the key in transplantation surgery, said Manian.
“The latest norms have extended the whole process of organ transplantation. Earlier, the whole process used to be finished within 24 hours. Now, the documentation alone takes 24 hours. Then allocation and retrieval time and wait for the Covid-19 tests adds an extra 24 hours. Now, the complete process takes around 48 hours or more. It becomes detrimental for the patient and has led to deaths as well,” he said.
Dhir said that waiting for RT-PCR tests for Covid-19 becomes life-threatening for the patients.
“The interval between requesting the family of the deceased donor and procuring the organs already takes much time. Plus sometimes, the hemodynamic stability of the patient is so small that we cannot wait for RT-PCR reports which generally take a long time to arrive,” he said.
However, Dhir and Manian added that the process is mandatory to follow as it ensures the safety of the patient, as if a patient contracts the virus, his or her survival chances decrease by 90 per cent.
Asymptomatic donors pose a significant threat
The doctors also said that the asymptomatic donors are another hurdle in the organ transplantation.
“The RT-PCR test’s false negativity is assumed to be 30 per cent, and that is why the transplants went down substantially in April and May as there was extreme concern about the living donor’s COVID status. If the donor is an asymptomatic carrier and we somehow miss it, the patient would suffer from a lung infection, and it would be difficult for him to survive,” said P.N. Gupta, Head of Nephrology and Kidney Transplant, Paras Hospital in Gurugram.
Despite all this, the experts agreed that the government should step in to facilitate the organ donation service.
Prof Subhash Gupta, Chairman of Centre for Liver and Biliary Sciences, said that the government should step forward and roll out schemes to increase organ donation.
“India’s annual requirement of organ transplantation is nearly 3 lakh but it does only 2,000 to 3,000 transplants. It is a costly surgery, and the governments should subsidise it like other forms of treatment. Besides, they can also make a provision for the donors, or their kin (in case of death) could receive some health benefits against the noble cause of organ donation,” he added.