Viable organs from deceased donors go unused as Ontario hospitals pause some transplants

Some viable organs have not been recovered from deceased donors in Ontario in the wake of the COVID-19 pandemic, as hospitals in the province temporarily scale back procedures that aren’t deemed essential, according to a leading transplant specialist in Toronto.

Hospitals across the province have hit pause on many transplant procedures, involving both live and deceased donors, unless the recipient patient’s life is considered to be at risk.

Organs from a deceased donor need to be transplanted quickly after death, but since some transplant procedures are now on hold, viable organs are not being “procured” from deceased donors’ bodies.

“It’s not like we can save the organ for a month on ice and then transplant it. That technology doesn’t exist yet,” said Dr. Atul Humar, director of the transplant centre at Toronto General Hospital. “So unfortunately what that means is that … we’re not proceeding with the transplant.

“We don’t send out a team to the donor site, to the donor hospital, and procure the organ from them.”

Fears COVID-19 could overwhelm Ontario hospitals

Humar said he is concerned that if hospitals in Ontario are overwhelmed with COVID-19 patients — the way they have been in Italy and Spain — some would-be recipients could ultimately die because they don’t get a transplant in time.

“My biggest fear, to be honest with you, is that there is going to be many people who won’t be able to get a transplant in time. And we’re going to … see deaths due to COVID, but we might see deaths due to patients who aren’t able to get a timely transplant,” he said.

Pausing some transplants is difficult, Humar acknowledged, but necessary in the current “unprecedented situation.”

“It breaks my heart. Every transplant that we do is a life-saving operation,” he said.

Dr. Atul Humar is director of the transplant centre at Toronto General Hospital. He says some organs from deceased donors are not being ‘procured’ as hospitals reduce transplant procedures due to the COVID-19 pandemic. (University Health Network)

Humar said his clinic usually performs an average of two organ transplants per day. But in the last two weeks, they’ve only performed a total of three transplants.

Procedures are still going ahead if the recipient urgently needs a new organ, he said, particularly in cases involving heart or liver transplants. But in many cases, people can safely wait to get a transplant until after the pandemic passes.

“Patients who need a kidney transplant can wait on dialysis — and they actually do reasonably well on dialysis,” he said.

The other risk in performing transplant operations right now, Humar said, is that patients who have a successful transplantation need to take anti-rejection drugs that “suppresses, or knocks down, their immune system.”

Those with compromised immune systems have a harder time fighting infection, which also puts them at greater risk when it comes to COVID-19.

“We’re trying to balance the risk and benefit to transplantation.… We’re in a very unusual and really unprecedented situation here,” said Humar. “So we’re trying to prioritize those who need the transplant.”

Transplant patients won’t lose spot on waiting list

Patients in Ontario who have transplant procedures delayed due to COVID-19-related changes will not lose their spots on organ waiting lists, according to the Trillium Gift of Life Network, the government agency responsible for Ontario’s organ and tissue donation and transplantation services.

The agency is in constant contact with hospitals around the province as the coronavirus pandemic ramps up, according to Dr. Darin Treleaven, chief medical officer of transplantation with Trillium.

“We know from our colleagues in Europe that there is tremendous strain being placed on hospitals there, and a tremendous strain in particular in the [intensive care units] there,” said Treleaven.

The agency is trying to anticipate what the impact might be on Ontario’s health-care system in the coming weeks, he said, which is why it’s now advising only critical transplant procedures move ahead.

There are nearly 1,600 people currently awaiting a transplant in Ontario, according to statistics compiled by Trillium.

Ontario patients told ‘everything is on hold’

It’s a stressful time for many people in Ontario currently waiting for an organ, including Paris Escandón, who is waiting for a new kidney from a living donor. Escandón said he was told by his Ottawa clinic two weeks ago that “everything is on hold right now” as the COVID-19 pandemic continues.

“It worries me, because more time goes by, and I am on dialysis, and my health gets worse,” said Escandón, a self-employed graphic designer who is married with two kids.

Paris Escandón is waiting for a kidney transplant from a live donor, but has been told the program is currently ‘on hold.’ (Submitted by Paris Escandón)

“I’m basically wondering when all this is going to end, and when I’m going to be able to continue with the transplant protocol, so we can continue with our lives.”

COVID-19 is also causing extra stress for those who have recently received organ transplants and are now on anti-rejection drugs.

Alexandre Lacelle said he takes a “cocktail” of anti-rejection medication every 12 hours, suppressing his immune system. The Ottawa father had two liver transplants in December; his body rejected the first transplant, forcing him to undergo another procedure eight days later.

Ideally, Lacelle said he would be kept “in a bubble during this time,” but that’s not possible because of his two kids. He also needs regular visits from a nurse to tend to his incision.

Alexandre Lacelle is on a daily ‘cocktail’ of anti-rejection drugs that suppress his immune system. But he says it’s hard to live life in a bubble generally, but particularly amid the coronavirus outbreak. (Submitted by Alexandre Lacelle)

Consider organ donation, doctor urges

Lacelle said he feels for people in Ontario who are now going to have to wait even longer to get an organ.

“It is very heartbreaking to think about all those poor kids, the poor families and what they’re going to go through,” he said.

“I really hope this ends soon so that other people can get on — get their transplant and have a happy life or happy second chance.”

For that to happen, Humar said it’s more critical than ever that people in Ontario consider organ donation.

“I want to stress to people that it’s still very important to support organ donation, [to] register to be an organ donor,” he said. “You know, organ donors are life-saving.”