Spain has performed 274 organ transplants from 127 donors during COVID-19

Spain has carried out 274 organ transplants during the health crisis caused by the new coronavirus, despite the enormous difficulties posed by the peak of the pandemic. To resume the excellent pace of previous activity, while continuing to guarantee patient safety, the National Transplant Organization (ONT) , together with the autonomous communities, has launched a Post-COVID Plan to reactivate a program that, like other activities, has been greatly affected during the crisis.

According to ONT data, until March 12, activity remained at very high levels, with an average of 7.2 donors and 16.1 daily transplants, figures even higher than last year. From March 13 to May 19, 274 transplants have been performed from 127 donors (148 kidney, 77 liver, 34 heart, 11 lung, three pancreas-kidney and one liver-kidney), corresponding to an average of 1.9 donors and 4 transplants per day.

Donation and transplantation is an essential activity of the National Health System. However, due to the exceptional health circumstances we are experiencing, the number of interventions has been reduced, although the Spanish transplant program has managed to remain open and in the last four weeks there has been a significant improvement. As the health crisis is being overcome, the ONT appreciates a progressive recovery in activity and hopes to return to the pre-pandemic figures. The donation and transplantation process is a good thermometer of the situation within hospitals, so if this trend is confirmed, it would indicate an improvement in the level of healthcare saturation.

Thanks to the transplant and coordination network and donors

Although the number of transplants in these weeks has been less than usual in our country, each one of the transplants performed has involved a huge effort on the part of all the professionals involved given the epidemiological situation, which increases the complexity of the procedures.

In this sense, the ONT highlights the important work of transplant coordinators in hospitals. They constitute the basic pillar of the Spanish Transplant Model. Most of them are professionals from the critical units. During the health crisis they are making a double effort, since they have fought the infection by the new coronavirus in the first line, attending to the affected patients, while being able to maintain the activity of donation and transplantation.

The ONT also praises the enormous generosity of the citizens of our country, which continues to show a very favorable attitude towards donation despite current circumstances.

Specific protocols against the new coronavirus

On January 23, the ONT issued the first recommendations to guarantee the safety of donation and transplantation in relation to the new coronavirus. The recommendations have been developed with the Autonomous Transplantation Coordinations and with the Immunocompromised Infection in Transplantation and Host Study Group (GESITRA-IC) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC).

Since then, these recommendations have been updated as the COVID-19 infection has become more widely known. To date, the potential for virus transmission by transplantation is unknown. In this situation, the guidelines issued are based on the principle of maximum caution:

  • Donation is discarded in the case of people with COVID-19 or symptoms compatible with the infection.
  • In people who have overcome the COVID-19 infection, donation requires a minimum of 21 days from the resolution of symptoms and the end of treatment, with two negative microbiological controls separated by a minimum of 24 hours
  • In the rest of the cases, a screening with a PCR test is performed. If the result is positive or inconclusive, the donation is also discarded.
  • Similarly, in transplant candidates, infection with the new coronavirus is ruled out immediately before surgery.
  • Given the restriction on the mobility of health teams between centers, the removal of organs by local teams has been promoted, avoiding the movement of professionals from other centers or Autonomous Communities.

A plan to reactivate the donation and transplant program

The ONT and the Autonomous Transplantation Coordinations have designed a specific "post-Covid" plan to recover activity prior to the health crisis as soon as possible, with security guarantees for living donors, transplant recipients and the health professionals involved. in this activity, a Plan that is already giving its first results.

The Plan foresees the progressive reactivation of organ donation and transplantation programs, resuming elective (non-urgent) procedures, which have already been launched in many regions, and living donor transplantation. Each center does it individually according to its epidemiological situation, although the critical point is the existence of COVID-19 free circuits.

The continuous adaptation of the protocols to the knowledge of the disease and the commitment to researching the impact of the new coronavirus on transplant patients are other elements of the Plan. The reinforcement and recognition of the transplant and coordination network and the commitment to its continued training are basic pillars to face the "post-COVID" era.

During these weeks, it has been demonstrated once again that the national donation and transplant program is an excellent example of cohesion and cooperation between autonomous communities within our health system. All professionals and entities from different sectors involved in this process have joined efforts to enable transplantation of patients who need it most anywhere in our country.

Finally, the ONT thanks donors and their families for their enormous generosity, as well as the group of social sectors whose collaboration contributes to saving lives through transplantation.

Special operation for the international transfer of bone marrow

Regarding the activity of transplants of hematopoietic progenitors (bone marrow and peripheral blood), from March to May 15, 41 transplants have been performed from non-family donors, while in the same period of the previous year there were 99. It is important to note that, throughout May, products that are cryopreserved and that have been shipped during the last two months remain pending for transplantation.

Regarding donations made in our country, data from the ONT-Spanish Registry of Bone Marrow Donors (REDMO) also confirm a total of 30 from an unrelated donor between March 1 and May 15, compared to the 44 donations from the same period of 2019.

The international operations for the transfer of hematopoietic parents count on the collaboration of the Civil Guard and REDMO to guarantee that, despite the logistical restrictions derived from the health crisis, these parents can reach their destination to carry out a transplant. Between March 16 and May 15, 39 products have been received in Spain and nine have been shipped outside our borders.

There are two interrelated reasons that explain the decrease in activity in the worst moments of the crisis. The first, the overload of the health system and the Intensive Care Units (ICU) that have been devoted to the care of patients with COVID-19. It is important to remember that the donation of deceased persons occurs in the ICUs and that a large part of the patients must be admitted to these units during the immediate post-transplant.

The second reason is related to security. Transplanted patients receive immunosuppressive therapy to prevent rejection of the transplanted organ, making them vulnerable to infections in general and COVID-19 infection in particular. The effort to avoid infection in this group of patients at times with limited COVID-19 clearances also explains the reduction in the number of procedures.

At the most critical moments of the health crisis, priority has been given to patients in zero emergency or in a very serious clinical situation, for whom the transplant cannot wait, as well as patients difficult to transplant due to their immunological characteristics or size ( in case a suitable donor appears during the crisis). In this last sense, the transplant of 25 children on the waiting list and 30 patients in zero emergency in the last ten weeks stands out.

During this period of time, five hyperimmunized kidney patients have also been able to transplant, thanks to the PATHI program. In the last four weeks, the improvement has been demonstrated with the expansion of criteria at the time of the transplant and even the first living donor kidney transplant has been performed, a program that had remained inactive during the crisis, since they are scheduled interventions that, in general, they can be postponed.

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