Covid first wave stops one in four organ transplants in Catalonia

Santa Coloma de GramenetWithout intensive care beds or health professionals to operate on them, people awaiting an organ transplant have experienced the other side of the epidemic in their own skin: that of taking a back seat in the health system, despite needing it more than ever. Used to being leaders in transplants and donations in the European ecosystem and after seven years heading record data, the epidemic has truncated the success of Catalan hospitals, which had to suspend many of these interventions for three months to cope with the virus. Specifically, last year a total of 997 organ transplants were performed, 23% less than in 2019, when 1,296 interventions were achieved.

The most frequent transplants of last year were kidney (677), liver (188) and lung (73) transplants, figures that fell by up to 40% from the previous year in the case of the latter. Heart transplants suffered the most drastic fall: from 70 operations in 2019 to 36 last year; in other words, these were cut in half. In contrast, liver and pancreas transplants have only declined by 4.6% and 15%, respectively.

These figures have set Catalonia back five years to 2015, when 955 transplants were performed. During the peak of the health crisis, between the months of March and May, transplants were limited to paediatric patients and urgent cases, which are those who need the transplant of a vital organ to survive. "2020 has been a very complicated year but, despite the pandemic and thanks to the efforts of professionals, we have performed almost a thousand transplants", the Catalan Minister of Health, Alba Vergés, said at the annual press conference held on Tuesday to take stock of the activity of the Catalan Organisation for Transplants (OCATT).

Health authorities emphasize that when the hospitals were able to recover part of this important surgical activity, starting in the summer, progressive access was guaranteed. Inaddition, they highlight that pediatric transplants have once again broken their own record, with 54 interventions, the majority (47) performed at the Vall d'Hebron Hospital. Last year 24 child kidney transplants were performed; 19 liver transplants; 6 heart transplants and 5 lung transplants.

"During the first wave, thanks to the lesser effect of the covid on children, the pediatric transplant programs were open, and this made it possible to maintain or increase activity during the more complicated months", the president of the Catalan Society of Transplantation and head of the kidney transplant unit at Vall d'Hebron Hospital, Francesc Moreso, explained.

In contrast, adult transplants practically disappeared during the first wave: in March there were 29; in April only 7, the lowest documented figure, and in May 36. The epidemiological setback caused the rate of transplants per million population to fall to 128 implants. In 2019, 169 were being performed.

Fewer donations

When all hospitals became coronavirus-dedicated and continuous care spaces, one of the first decisions of the centers was to suspend all non-urgent surgery to free up ICU spaces for coronavirus patients. Healthcare providers did not dare to expose patients due to their extreme vulnerability. Moreover, even if they had wanted to, they could not have done so: most surgeons had become intensive care doctors and nurses were fully dedicated to the covid. "The first wave was traumatic: it suddenly stopped all transplant activity", Moreso summarises.

It was only in June that some activity could be recovered, and even now hospitals are still struggling to alleviate the serious effects of the shutdown and return to normal. Above all, they are working to avoid having to close the operating theatres again, now that the third wave is hitting hard. During the second wave the onslaught of the virus did not cause the transplant curve to oscillate, but quite the opposite: the number of operations remained relatively high, with around one hundred implants per month.

As most of the implantations were postponed for three months, not only were the transplantations reduced to their minimum in the first quarter of the year, but also the organ donation processes stopped in their tracks. Last year, 29 per cent fewer organs were donated than in 2019: from 510 valid cadaver donors to 267. In addition, there has also been a 17 per cent drop in living donors, from 134 in 2019 to 111 last year. Indirectly, the pandemic has curbed an altruism that Catalonia had always been able to boast about.

However, Vergés wanted to highlight the uterus transplant carried out by the Hospital Clínic last month between sisters, the first in the whole of Spain, and the third live donor transplant carried out by the Puigvert Foundation together with Portugal, the first in the international sphere in southern Europe.

In addition, the Blood and Tissue Bank of Catalonia distributed 13,133 tissue units in 2020: 2,716 eye tissue units; 9,646 musculoskeletal tissue units; 465 skin tissue units and 306 cardiovascular tissue units. Another positive figure was the increase in bone marrow donors in Catalonia, which rose from 56,509 to 61,536 despite the impact of the pandemic.

The director of OCATT, Jaume Tort, noted that there has been a drop in donors due to traffic accidents, which is closely related to the country's shutdown and home lockdown, with 2.6% of total tissue donated by deceased persons. In 2019, however, they accounted for 6.1% of cases. In total, the 378 alive and cadaver donors, managed at the 23 authorized centers in Catalonia, have generated 1,031 organs suitable for transplant.

Biased waiting lists

Although donations and transplants have gradually increased, partly because the system has been adapted and has established differentiated circuits to ensure the safety of the facilities, at the end of the year it was still not possible to recover pre-pandemic levels. Although a priori the waiting lists for an organ have been reduced and this year there are only 1,073, when in 2019 there were 1,217, Torthas admitted that this is a biased interpretation.

"No new patients have been included due to decreased outpatient and referral activity, especially during the critical phase of the pandemic", he said. In short, fewer candidates entered the list last year than in other years, and therefore figures "should be higher". Specifically, on 31 December there were 925 people waiting for a kidney, 40 for a liver, 31 for a heart, 53 for one or two lungs and 23 for a pancreas. Of these, 14 are children and adolescents.

Regarding consent to organ donation, although eight out of ten families of donor candidates consented to the removal of the organs or followed their relative's wishes (advance directives or verbal statements), 16.5% opposed the donation of a relative's tissues to another person. This is 0.5% less than in 2019. Most of the objections were made by relatives who did not give any specific reason or by the potential donor himself, who said so in advance. Also noteworthy were refusals due to family doubts about physical integrity after death and for religious reasons.