Almost two years after organ transplants were suspended due to Covid-19, which increases transplant patients’ risks of dying, some public health specialists say it is time to consider reviving this life-saving procedure.
Kidney specialists from two of the Western Cape’s biggest hospitals, Tygerberg and Groote Schuur, said despite the tremendous pressure on public hospitals to treat patients with end-stage kidney disease, severe bottlenecks on the dialysis programme had been worsened by the suspension of kidney transplants. This, with a shortage of dialysis machines, had created an “untenable situation” for doctors and their patients. As a result, dialysis machines were not being freed up, restricting new patients’ access to them.
In a South African Medical Journal (SAMJ) article, nephrologists from these hospitals urged health authorities to relieve the pressure by not only vaccinating dialysis patients against Covid-19, but increasing theatre time and allowing more organ transplants.
One of the concerned nephrologists, Dr Yazied Chothia, who is also a senior lecturer at Tygerberg Hospital and Stellenbosch University, said with more medical-insured people losing their jobs, the pool of patients joining the state healthcare sector was expected to increase and put the under-resourced system under severe strain.
“We anticipate a tsunami to hit the public sector in the coming months or years.”
Allowing living donor transplants (donors who donated to a family member), especially given the low rates of Covid-19 infections currently, would make a huge difference and open up dialysis machines to new patients.
— Dr Yazied Chothia
While it’s been proven Covid-19 increased mortality of transplant patients substantially — about 10 times that of the general population — Chothia said allowing living donor transplants (donors who donated to a family member), especially given the low rates of Covid-19 infections currently, would make a huge difference and open up dialysis machines to new patients.
Currently, new patients on the waiting list for dialysis were only slotted in if dialysis patients died, mostly due to Covid-19.
“Due to the shortage of staff in the operating theatres, we have limited theatre time available per month to electively transplant living donor transplants. As these types of transplants are predominantly under our control, increasing access to theatre will allow the availability of the desperately needed dialysis slots,” he told Sunday Times Daily.
Other nephrologists who co-authored the SAMJ report include head of nephrology at Tygerberg Hospital and Stellenbosch University Prof Mogamat Razeen Davids, Dr Johan Nel and Dr Zunaid Barday, from the University of Cape Town (UCT) and Groote Schuur Hospital.
All transplants in the public and private sectors were temporarily suspended in March last year due to the negative effects Covid-19 might have on immunocompromised patients and to prioritise those with Covid-19. While organ transplants had restarted recently, these specialists said the uptake of Covid-19 vaccinations, which were highly recommended for all transplant and dialysis patients, remained very low in this group.
“We have always had bottlenecks for kidney transplants, even before the Covid-19 pandemic. The number of new and existing dialysis patients on the waiting list continues to exceed our ability to procure organs for transplantation. This is not unique to South Africa, but is a worldwide phenomenon. The Covid-19 pandemic has only amplified the shortage of transplantable organs,” said Chothia.
This is not unique to South Africa, but is a worldwide phenomenon. The Covid-19 pandemic has only amplified the shortage of transplantable organs.
— Dr Yazied Chothia
A Cape Town private-sector nephrologist, Dr Trevor Gerntholtz, agreed that the suspension of kidney transplants had reduced access to dialysis machines. “It has got a lot busier during the Covid-19 pandemic, but in the private sector they have created more shifts, such as night shifts, to accommodate as many patients as possible. They also brought in more machines as money is not as big a problem in the private sector as it is in the public sector.
“There were a lot of people who developed kidney failure during Covid-19. That, plus the fact that we are not doing any kidney transplants, kept us very busy,” he said.
Dr Willie Koen, a cardiac and transplant surgeon at Netcare Christiaan Barnard Memorial Hospital in Cape Town, said the shortage of donors and suspension of transplantation had seen more demand for mechanical hearts. He said there were currently no plans to bring back transplantation in the private sector during the pandemic.
“Transplant patients have to go on immunosuppressant drugs, which reduces immunity. And if somebody who had a transplant contracts Covid-19, even if they are vaccinated, they are not strong enough to fight the virus because their immune system is down. In our transplant programme we lost a lot of patients to Covid-19 and the mortality rate was 50%. These include patients who had been doing very well over the years. Some had their transplants more than 10 years ago. That is by far the highest mortality we’ve had on the programme.
“We cannot ethically justify transplanting anyone at the moment. What we try to do if people are so desperate [is provide a] mechanical heart, which doesn’t need any immunosuppressants. With this small pump people can still go home, and if they get Covid-19 they have the same chance to survive as the general population. We hope to have these patients transplanted maybe in three years, when hopefully the Covid-19 situation is better, he said.
Mark van der Heever, spokesperson for the Western Cape department of health, said there was hope for transplant patients as provincial hospitals were re-escalating surgical lists to pre-Covid-19 levels.
“In this current inter-wave period, theatres are now staffed as they were pre-Covid-19. Our hospitals are performing catch-up sessions on cases that could not access theatre during the Covid-19 waves. But this catch-up is being hampered by the resurgent load of trauma cases that also need access to theatre time, often as emergency cases.”
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