The coronavirus pandemic and the national lockdown that followed brought organ transplants in India to a complete standstill.

But as cities begin to unlock in phases and hospitals gradually steer the focus to other chronic ailments and lifesaving procedures undermined by Covid-19, organ donations and transplants are slowly resuming.

On Aug. 17, the family of a 31-year-old man from Kolkata in West Bengal consented to donate his organs after he was declared brain dead as a result of severe injuries he suffered in a road accident. The noble gesture marked Kolkata’s first organ donation  during the pandemic and third this year. The two others occurred in January.

In a similar gesture on Aug. 15, the family of a deceased 39-year-old woman from Pune saved the lives of five patients suffering from end-stage organ failure. The donor had suffered a brain hemorrhage and her family consented to donating her heart, liver, lungs, kidney and cornea after doctors declared her brain death. Two of her organs were flown to south India; the heart was sent to MGM Healthcare in Chennai; and the lungs were sent to KIMS Heart and Lung Transplant Institute in Hyderabad. The remaining organs were transplanted to patients in Pune.

“This was only the second heart transplant that we carried out in our center since the country went under lockdown,” said cardiac anesthesiologist and critical care specialist Dr. Suresh Rao.

 

Rao was part of the heart transplant team in Chennai’s MGM Healthcare. “Usually, we carry out anywhere between eight to 10 heart transplants in a month. But since the lockdown in mid-March, we have carried out only two,” he said.

Before Covid-19, the number of transplants done annually in India was about 5,ooo kidneys, 1,000 livers and 50 hearts, according to the Journal of the Practice of Cardiovascular Sciences.

The first case of Covid-19 was reported in India on Jan. 30. A nationwide lockdown was announced by Prime Minister Narendra Modi from March 24 as the number of cases began to soar. The country has now crossed 2.7 million cases and recorded more than 50000 deaths.

“The state governments advised to stop the transplant procedures due to the concern about the outcome if patients get infected with Covid-19,” said Rao. “The Tamil Nadu government lifted this clause last month and allowed hospitals to restart transplants if organs were available within their centers. Now the government has allowed inter-city transplants too, thus enabling us to fly the organs from other states.”

However, the process remains challenging due to the low number of domestic commercial flights operating in the country.

“We had to arrange a chartered flight with help from a charitable trust to bring the heart from Pune to Chennai,” Rao said, referring to the organ donation on Aug. 15.

In Western India, the State of Maharashtra recorded 160 organ donations in 2019. So far this year, the state has recorded 50. Maharashtra currently has over 5,500 patients waiting for kidney transplants, nearly 1,100 waiting for liver transplants, 74 waiting for heart transplants, and 16 in line for lung transplants. While patients with kidney failure are sustained on dialysis, those in need of other organs have little interventions other than transplants.

The living donor organ transplants, where a close relative is allowed to donate the organ, also took a back seat during the pandemic. In some cases, organ donors and recipients feared contracting the infection and delayed the procedure, while in other cases hospitals they had registered with had halted the program.

“It is logical to presume that patients on the waiting list who did not get transplants in time may have succumbed. But we currently don’t have any data on this,” said Dr. Vasanthi Ramesh, director of the National Organ and Tissue Transplant Organisation. “Hospitals are still busy with Covid-19 and the health systems are stretched. We will collate the data from centers in the coming days”.

Some transplant centers have calculated the mortality based on their own waiting list. Chennai’s MGM Healthcare has lost nearly 30 percent of its patients on the waiting list for heart transplants.

“Patients in need of heart transplants have to wait anywhere between one to three months to get the organ. However, this year, the waiting period had crossed six months for most patients,” said Rao.

Doctors say that ensuring a COVID-free pathway before and after the transplant is most challenging. This fear is probably keeping most hospitals away from restarting their transplant programs, even as it is not economically viable for them to sustain.

“In Mumbai, we have 39 recognized transplant centers but only one-third have agreed to restart the procedures,” said Dr. SK Mathur, president of the Zonal Transplant Coordination Centre, Mumbai. A similar trend in reduction in the number of transplant procedures has been recorded in the United States and France.

Gradually though, states have devised standard operating procedures to minimize the risk of infection. Tamil Nadu government, for instance, has insisted that not just the donor and the recipient, but also close family members of the recipient be tested for Covid-19. In Maharashtra, patients and healthcare workers must be screened and followed up for up to 28 days.

Doctors believe the number of transplants will increase in coming days after speedier test results for Covid-19 tests and increased public awareness of safety measures to control spread of the virus.

(Edited by Siddharthya Roy and Judy Isacoff.)



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