Patient had been waiting for a kidney. It finally arrived, but coronavirus stopped it
Lisa Jones hung up the phone. The kidney would be at the lab at 2:30 a.m.
From her home office in Seattle, Jones — whose job is to match organs with recipients — started making more calls. The donor had already been tested for COVID-19. She also had to ensure that a member from the surgical team would be available to meet the kidney and put it on a pump, which would help preserve the organ until it could be delivered to the hospital.
Forty-eight hours. That’s about how long the entire team of organ procurers, couriers and surgeons had from the moment the kidney left the donor’s body until the odds of a successful outcome no longer played in a patient’s favor. The flight alone took nearly six hours. The kidney was coming from Florida. The possible recipient was scheduled for surgery in Washington.
The organ procurement organization Jones works for, the Bellevue, Washington-based LifeCenter Northwest, doesn’t typically fly kidneys from such a distance. But that day, Jones was serving as back up to a more local organ procurer who would usually try to place the kidney somewhere in Florida.
A few hours later, Jones’ phone rang. The kidney’s flight was canceled because of the coronavirus. A new flight had to be rebooked, which would get the kidney there at 12:15 p.m. That added another 10 hours.
They could still make it.
Four hours later, her phone rang again. The second flight had also been canceled.
There was no longer enough time to try again. Jones made a call, the first in a series that ended with a doctor telling the patient that no kidney would be coming after all.
Patients can wait years for organ donations. Now, some patients are having to wait even longer, as the coronavirus disrupts the complex system that matches donors with those in need of life-saving organs.
Flight cancellations are keeping kidneys from reaching recipients. Hospitals in some hard-hit parts of the country have reduced transplants out of fear that they could put patients at greater risk, even though the Centers for Medicare and Medicaid Services categorizes transplants as “do not postpone” surgeries. Other hospitals are limiting organ-removal operations on living donors as they choose to conserve personal protective equipment and ventilators for the battle against the new coronavirus.
“It’s very frustrating,” said Jones in a phone interview. “You know you have a beautiful organ — You just have to figure out a way to get it to the patient.”
Hospitals slow surgeries on living donors
Amishi Desai heads the division of kidney transplantation at the Loyola University Medical Center in Maywood, Illinois, a Chicago suburb. Her team normally performs eight to 12 kidney transplant surgeries per month, she said. In the last three weeks, they have performed just two.
That’s because the hospital in March decided to reduce the number of surgeries on living kidney donors.
“We’re moving forward with caution to assure the most safety for the patients,” Desai said by phone.
By this time last year, transplant teams across the country had performed 1,800 living-donor transplants. They were on pace to repeat that this year — until the coronavirus outbreak in mid-March. Since then, just 69 transplants have taken place, resulting in 300 fewer so far this year than last.
Transplants require highly specialized skills, and most hospitals do not perform them. Patients in some small-population states, like Idaho, must travel hundreds of miles out of state to receive organs.
Over 100,000 people nationwide are holding out hope for kidney transplants. According to the American Kidney Fund, the average wait is five years.
With the coronavirus spreading so rapidly, doctors fear it has become more dangerous to operate than not.
Doctors typically prescribe a medley of immunosuppressants after a transplant. The drugs keep a patient’s body from attacking the new organ, but they can also keep the immune system from attacking infectious diseases like COVID-19.
“Our immune-compromised patient population is at a higher risk,” Desai said. “Once you transplant ... the fear is you may be making them more susceptible to illness.”
So Desai and her colleagues are resorting to other ways of treating patients awaiting kidneys.
Most patients can prolong their lives with dialysis, a burdensome treatment that requires patients to travel to a clinic three times a week for four-hour sessions in which blood is pumped out of the body into a machine, filtered and returned.
Dialysis carries its own risks, said Holly Kramer, a fellow nephrologist at Loyola and president of the National Kidney Foundation. Just by leaving the house and traveling to a clinic, patients may expose themselves to the virus.
Kramer said she is sad to have to continue dialysis for her patients who have waited for years for a kidney.
“We’ve said, ‘OK, dialysis is going to be a bridge,’” she said. “That bridge is now going on two years. As time goes on, you’re constantly telling them, ‘This is the year.’ And now, this is happening. It’s yet another roadblock for a patient.
“This is really tragic,” she added. “A transplant is a life-sustaining, life-changing treatment.”
Charts based on data from the United Network for Organ Sharing.
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Liver-failure patients have also had living donor surgeries postponed. But unlike kidney patients, there is no interim treatment, said Donna Cryer, president of the Global Liver Institute, a nonprofit that advocates for liver patients.
“That has caused quite a bit of distress to many patients, to be told that you have end-stage liver disease ... that you have to wait indefinitely,” Cryer said by phone from Washington, D.C.
Although living donor transplants in 2019 made up just 523 of the 8,896 liver transplants performed last year, Cryer still urges hospitals to keep scheduled surgeries on the books.
“In areas that aren’t over-stressed, we shouldn’t trade the health and the care of a transplant candidate today for candidate of a future hypothetical COVID patient a week or two from now,” she said. “What I worry about in this era is that we may do a good job of capturing data on deaths from COVID-19, but we may not capture a lot of deaths from postponement of care that should have gone forward.”
Deceased donor transplants continue
While hospitals have slowed living donor programs, deceased donor transplants are still roughly on pace with last year, according to the United Network for Organ Sharing.
But organ procurement organizations are having to work even harder to navigate around the logistical complications created by the coronavirus pandemic, said Craig Van De Walker, executive director of the Pacific Northwest Transplant Bank. His Portland-based nonprofit evaluates and matches organ donations with patients in Oregon, Idaho and central Washington.
“A living donor transplant can be scheduled; you have the luxury of controlling the timing,” he said by phone. Deceased donors represent one-time opportunities that expire a day or two after death, which makes matching them with patients all the more urgent.
The procedure to place vital organs like hearts and lungs hasn’t changed substantially during the coronavirus crisis, Van De Walker said. After those organs are removed from donors’ bodies, they are sent on chartered flights to their eventual recipients. A chartered flight from Boise to Portland can cost $3,500. A flight from Hawaii to Portland can cost $70,000.
Kidneys, though, fly commercial. Van De Walker said his team is now spending more time trying to coordinate flights, sometimes having to postpone surgery on a deceased donor to ensure that the organs arrive to their recipient in a viable form, even if it means keeping a brain-dead donor on a ventilator a few days longer.
“Time is of the essence,” he said.
But as hospitals become overwhelmed with COVID-19 cases, some doctors wonder if they will have enough ventilators to keep donors on life support for the days needed to procure and place organs.
“There are hospitals that are in crisis that can’t give up a ventilator for someone who’s not critically ill,” said Kramer, the Loyola nephrologist. “While transplantation is life-saving, they’re trying to keep ventilators for emergency situations.”
Kevin O’Connor, president and CEO of LifeCenter Northwest, echoed Kramer’s concerns early on in the pandemic. But both he and Van De Walker say they have yet to see hospitals in the Northwest take ventilators away from donors to use on coronavirus patients.
“It’s very much dependent on where you are in the country,” O’Connor said by phone. “In places that are seeing a high level of admission for patients who need testing for COVID-19, the resources are constrained. But in other parts of the country that are not seeing as high volumes, there are still sufficient levels.”
Already, trying to find a donor match can be daunting. A donor must be free of diseases like hepatitis or cancer. Donors and recipients must have matching blood and tissue types.
Now, at Loyola, Desai and her fellow doctors are setting up even more precautions to determine whether a patient should be considered for a donation amid the pandemic to lower the risk of the patient rejecting the organ, which would make the patient highly vulnerable to infection.
Desai’s team is planning to perform transplants with deceased donor organs only for perfect matches, or what she calls “needle-in-a-haystack” cases, where the patient is unlikely to find another organ that matches them. Kidneys from deceased donors make up about three in five of the transplanted kidneys at her hospital.
But for other patients, Desai’s team is maintaining dialysis treatments and ensuring patients stay healthy long enough to get through the peak of the coronavirus.
“Transplants have always been about getting people off dialysis and getting people to live a normal lifestyle,” Desai said. “But we don’t live a normal lifestyle anymore.”
This story was originally published April 9, 2020 at 3:00 AM with the headline "Patient had been waiting for a kidney. It finally arrived, but coronavirus stopped it."
