Dual epidemics in Texas: Navigating kidney transplantation during COVID-19
June 10, 2020
Organ transplantation relies on generous donations from two communities: living donors and families who've lost loved ones to often unexpected situations such as a motor vehicle accident.
In regions hit hard by the coronavirus, both donor sources have declined. For living donation, it's because of efforts to reduce well-patient visits to hospitals and avoid elective surgeries such as donor nephrectomy.
In the case of deceased donation, physical distancing means fewer public encounters and, potentially, fewer accidents. Registered donors who do not survive an accident must still be brought to the hospital in time to procure the organs, which is a brief window.
Data from the United Network for Organ Sharing show that in the Northeast U.S. (including New York), deceased-donor transplants are down 19% year-to-date from May 24, 2019, to May 24, 2020.
In this same time frame, the South Midwest U.S. (Texas and Oklahoma) increased deceased-donor transplantation by 8%. The coronavirus pandemic in Texas did not result in a surge of infections as it did in more densely populated regions. But, unfortunately, North Texas also faces a kidney disease epidemic.
In Dallas and Tarrant counties, more than 28% of Medicare recipients have chronic kidney disease – up nearly 2% from the previous year and higher than the Texas average of 26.4% and the U.S. value of 24%.
With low coronavirus rates and the dire need for kidney transplantation, suspending our programs for the entire pandemic was out of the question. So, in early March, we paused for just two weeks to heighten our COVID-19 safety protocols, secure rapid testing kits, and set up our telehealth program.
Our region's Organ Procurement Organization (OPO), the Southwest Transplant Alliance (STA), was the first in the U.S. to implement COVID-19 rapid testing for all deceased-donor kidneys. And UT Southwestern was the first in the Dallas area to reinstate in-person evaluation of living donors for kidney transplantation.
On April 27, 2020, we resumed procedures with living donors for kidney transplantation. To be clear, transplantation itself is not elective. Receiving an organ is a lifesaving procedure. What's elective is removing a full or partial organ from a living donor – that is a donor's choice, though we know many living kidney donors feel otherwise.
As the world reopens, patients understandably have many questions as they wait for a new kidney, wait to donate, or recover from a recent transplant. In this guide, we’d like to answer our patients' most frequently asked questions. But we know there may be other questions, so don't hesitate to reach out if you need more information.
Surgeries in Sync
Two simultaneous surgeries with one single goal: to give the kidney recipient a new lease on life. Follow two surgical teams as they perform a living-donor kidney transplant.
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FAQs for patients on the kidney transplant waiting list
So far, the answer is no. In fact, the needs of our waiting patients' were the priority in our discussions to keep the transplant program going during the COVID-19 pandemic.
The average patient with kidney failure spends four to six years on dialysis waiting for a deceased-donor kidney. These patients typically visit their dialysis center three times a week for about four hours a session. That's 36 visits and 144 hours per patient in the center, just in the 12 weeks of pandemic from March to date.
Our Kidney Transplant Program team and infectious disease experts weighed the options. We could keep patients on dialysis during the pandemic, with potential yet low risk of COVID-19 exposure during their multiple visits. Or we could reopen our living and deceased-donor programs with rapid testing protocols and telehealth visits, allowing more patients to avoid dialysis altogether. It's clear that this option best serves our patients.
In deceased-donor situations, both you and the deceased donor will be rapid tested for coronavirus. We can get results within 30 minutes. If the deceased-donor organ tests positive for COVID19, we will not accept the kidney.
In living donor cases, we will test you and your donor a few days before surgery. If you both test negative for COVID-19, we'll ask the two of you to stay home as much as possible until the surgery and to follow the CDC's guidelines regarding face masks and handwashing. If either of you test positive, the procedure will be postponed.
Our team continues to be available 24/7. We are doing approximately 50/50 telehealth and in-person visits. Check-ins and follow-ups will generally be conducted via telehealth.
Dialysis centers and labs follow strict COVID-19 screening guidelines and low-volume scheduling protocols to keep patients safe. No public spaces are 100% risk-free – patients with COVID-19 can spread the virus for up to 14 days before symptoms appear. UT Southwestern and health care facilities we work with are doing everything they can to minimize exposure risks.
No. Following the CDC's coronavirus hygiene guidelines is sufficient to reduce your risk.
If you, your living donor, or the deceased-donor organ test positive for coronavirus, your procedure will be postponed.
Postponement will be a minimum of two weeks, even if the infected person does not have symptoms. This is the same protocol we would follow for any sort of viral or respiratory infection, including influenza.
We understand postponement is disappointing. For most patients, the risk of complications – severe inflammation, respiratory distress, or infection – outweigh the benefit of waiting a little longer for the procedure.
This is a good question. Unfortunately, we don't have a good answer yet. Antibody testing tells us whether you have been infected with COVID-19. Right now, it doesn't tell us much else.
COVID-19 is new, and there is no data yet on whether a positive antibody test means you are immune from catching the virus again. Right now, antibody testing may do more harm than good. Knowing you’re antibodies-positive may cause you to worry about who you may have exposed.
FAQs for living kidney donors
We resumed minimally invasive living kidney donation procedures April 27, 2020. We’ve also returned to normal clinic operations to complete physical and mental health examinations for donor evaluations. Your procedure will be done at the same time as the recipient's transplant in Dallas.
The risk of catching coronavirus at a hospital is extremely low. Every patient and visitor is screened before entering the hospital. Every staff member is, too, and we all gear up in personal protective equipment prior to seeing patients. See our COVID-19 safety procedures.
Absolutely. Start with our online application. A nurse will review your application and, if approved, we will arrange for lab work at a Quest location close to your home.
Right now, some application steps are completed via telehealth. However, we need to see you in person for imaging, physical and mental health exams. These steps are required – we need to be sure you feel confident and safe becoming a donor. Learn more.
FAQs for recent kidney recipients
For about six months after a kidney transplant, patients are at an increased risk of any infection due to anti-rejection drugs. However, COVID-19 data in post-transplant patients is limited and divided.
Some scientists think anti-rejection medications may protect transplant patients from severe coronavirus symptoms. A Vox article suggests these drugs may prevent a COVID-related cytokine storm – an uncontrolled inflammatory response to viral infection that has damaged patient's organs.
However, one study of 36 patients suggest those with previous kidney transplants may have mild COVID-19 symptoms early on but faster disease progression. The study showed these patients had a 23% higher rate of death compared to the general population. Nearly all patients had at least one risk factor for poor COVID-19 outcomes, such as diabetes, older age, or history of smoking..
At our center, fewer than 10 of our COVID-positive patients have had kidney transplants in the past. All have recovered except one who was many years out from transplantation and unfortunately had several other compounding health complications.
For now, we recommend that post-transplant patients follow the CDC's coronavirus hygiene guidelines, which are more stringent than standard post-transplant instructions.
If you think you might have COVID-19, the American Society of Transplantation recommends calling your transplant coordinator right away.
Call immediate if you develop any of the following symptoms:
- Fever higher than 100.4 F
- Severe nasal congestion
- Shortness of breath
- Sore throat
- Symptoms you feel are related to your transplant
If you are not experiencing chest pain or other emergency symptoms, call the transplant center before going to the clinic. We offer telehealth visits so you can speak with a doctor from the comfort of your home. Remember, it is also allergy season – in Dallas, all but five days in May registered medium to medium-high pollen levels.
Though the pandemic has limited some in-person visits, the UT Southwestern transplant team is available 24/7 to help you navigate the best course of care. Reach out by phone or request a telehealth visit. We will overcome these challenging times together.