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Breaking news: patients are waiting longer for kidney transplants due to COVID19. @UNOSNews has just released a useful tool showing this https://bit.ly/3c2G60y . It's not surprising. But let's review the situation & steps patients can consider in these challenging times.
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Live donor kidney transplants put both donors and recipients at risk of COVID and are no longer being performed by most programs. With luck most of the recipient/donor pairs who have been postponed will be transplanted later, perhaps 2nd half of 2020.
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Deceased donation has also declined significantly. Unfortunately these missed organs cannot be recovered. Possible contributors:
*Some ICU’s are overwhelmed with COVID care, leaving little slack for sensitive donor discussions, despite the strong commitment of the OPO's.
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*Some ICU’s are overwhelmed with COVID care, leaving little slack for sensitive donor discussions, despite the strong commitment of the OPO's.
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*Families aren’t allowed to visit ICUs and are less available to OPO staff.
*“Shelter in place” orders may have resulted in fewer accidental deaths – great for those who would have become donors, but not for those waiting for a kidney.
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*“Shelter in place” orders may have resulted in fewer accidental deaths – great for those who would have become donors, but not for those waiting for a kidney.
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*Some patients may not be seeking care for fear of acquiring COVID in a hospital– the “Where have all the Heart Attacks Gone” phenomenon. @hmkyale https://nyti.ms/2VeDA0w
*Some would-be donors are COVID+ and thus not candidates to donate
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*Some would-be donors are COVID+ and thus not candidates to donate
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*Quarantines are making it harder to get organs out of ‘hot spot’ cities.
*Transplant programs are being appropriately conservative with kidneys that might experience delayed graft function, knowing this will increase COVID exposure for recipient, via hospital or dialysis
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*Transplant programs are being appropriately conservative with kidneys that might experience delayed graft function, knowing this will increase COVID exposure for recipient, via hospital or dialysis
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So patients will dialyze longer, & some patients who were expecting a living donor transplant will need to start dialysis. This is upsetting but here are some things transplant candidates might consider to reduce the impact. (More later on what transplant programs might do)
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Especially if you’re on dialysis, first of all stop and pat yourself on the back: no one knows better than you how hard CKD and dialysis are, and on top of that you now have COVID to worry about. Dialyzing requires heroic commitment and patience.
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Skipping dialysis treatments for any reason, even COVID, is never a good idea. Dialysis is your lifeline and you significantly increase your chance of hospitalization or serious illness if you skip.
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As always do your best to follow the recommendations of your dialysis team. Sticking to the fluid restriction and diet, and taking your meds will all help keep you healthy enough for transplant.
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Exercise if you can! Keeping active and strong helps enormously with transplant.
Quit smoking if you haven't already.
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Quit smoking if you haven't already.
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Don’t forget to tend to your emotions – keeping your spirits up is critical if you can find a way, through your faith, meditation, therapy, exercise, or all of the above.
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Remember the kidney waitlist isn’t a lottery, it’s a queue – you will get to the front on the line! You just have to be healthy enough for transplant when you do. "For myself I am an optimist - it does not seem to be much use to be anything else." Winston Churchill.
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And now more than ever is the time to look for a living kidney donor. It’s easier & more effective to share your situation with friends/family than to ask for a kidney. Use social media & email to let them know how COVID is lengthening the transplant wait.
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