key: cord-0977942-o6zsw07w
authors: Pessoa, João Luís Erbs; Donnini, Oswaldo Antônio; Monteiro, Francisco
title: Impact of the COVID-19 Pandemic on Organ Donation and Transplantation in São Paulo, Brazil
date: 2022-04-22
journal: Transplant Proc
DOI: 10.1016/j.transproceed.2022.03.022
sha: 8e50b5d8657f294548b4c42b59db1c6b714ee46c
doc_id: 977942
cord_uid: o6zsw07w

The pandemic coronavirus disease (COVID-19) has impacted organ donation and transplantation activities in São Paulo, Brazil and the patients receiving these organs have also been affected. In this study, information from the database of the São Paulo Organ Allocation System was analyzed and compared in two periods, pre and during the COVID-19 pandemic to identify this impact. COVID-19 interfered in the mortality rate and the time on the waiting list for heart, liver, pancreas, lung and kidney transplants, number of effective donors and utilization or disposal of available organs from deceased donors. In addition, it reduced the transplant activity with living donors. Regarding the activity of eye tissue transplantation, the time on the waiting list increased and the number of transplant procedures decreased. The kidney transplant program was the most affected in our study. There was an increase in waiting time and mortality in the waiting list for this organ and also a decrease in kidney utilization rates.

around the world and in Brazil, where the donor rate declined by 13% in 2020 when compared to 2019 (3) . These reduction could have occurred both because of a decrease in notification of potential donors and also by an increase in the number of contraindications for transplantation. To minimize the effect of this pandemic in São Paulo, in April 2020, an RT-PCR test for SARS-CoV-2 was adopted in the screening of effective donors and protocols and flowcharts used in the clinical evaluation of potential donors were adapted. In addition, for liver and kidney transplantation with a living donor, it became the responsibility of each transplant center to perform the surgery. Regarding the activities of harvested cornea and elective corneal transplantation, they were suspended for 6 months, starting on 03/23/2020, only performing this surgery on an emergency basis and cornea harvested only from a deceased donor. The aim of this study was to assess the impact of COVID-19 on donation and transplantation using information from the São Paulo Organ Allocation System database.

METHODS: This is a cross-sectional, retrospective and descriptive study that analyzed information from the database of the São Paulo Organ Allocation System. The period of analysis was divided into prepandemic period (01-Apr-2019 to 31-Mar-2020) and during the pandemic period of COVID-19 (01-Apr-2020 to 31-Mar-2021). The following variables were analyzed between the groups: number of effective donors, utilization or discard of available organs, mortality rate and time on the list of patients waiting for heart, liver, pancreas, lung, and kidney transplants. Statistical Analysis was performed with Statistical Package for the Social Sciences (SPSS Inc, Chicago, IL). The Z test was used to evaluate two means and the test of equality of two proportions to evaluate two variables. A two-sided P-value ≤ 0.05 was considered statistically significant. Table -01 115 and 1,051) , respectively, although family refusal rate dropped from 36.6% to 33.4% (p = 0.052). Others have identified higher rates of mortality due to COVID-19 among deceased donor kidney transplantation waitlist (4) and also a reduction of organ donation in several countries such as in Argentina, Colombia and Poland (3, 5) .

The availability of organ donation from deceased donors before and during the pandemic periods of COVID-19 was as follows (Table -01 Mortality of candidates on the waiting list before and during the COVID-19 period increased for all organs ( Table -01) , however, it was significant only for pancreas/kidney candidates, which increased from 12.5% to 18.0% (p = 0.033), lung candidates that increased from 11.5% to 23.9% (p = 0.019) and for kidney candidates that increased from 4.6% to 7.4% (p < 0.001). A study that analyzed the COVID-19 database of the European Renal Association also identified that the probability of death of patients waiting kidney transplantation, after 28 days of contamination by COVID-19, was of 25% (8) and a multi-step systematic search of the literature performed by Alfano at all (9) identified a mortality rate of 47%.

Furthermore, in the US, the hazard of mortality among kidney transplant candidates was 37% higher in the first 10 weeks after the beginning of the COVID-19 national emergency (10) . On the other hand, in the current study, it was observed as shown on Table - There was an increase in waiting time and mortality in the waiting list for this organ and also a decrease in kidney utilization rates. On the other hand, actions promptly adopted in São Paulo to mitigate the impacts of COVID-19, such as carrying out the RT-PCR test for the diagnosis of Covid-19 in donors and recipients; the management of health care services with an area dedicated to patients positive for COVID-19; hospital managers working towards patient care and hospital safety and incentives to maintain donor viability activities alltogether positively changed the course of the donation and transplant program in the State of São Paulo during the pandemics.

Pathological findings of COVID-19 associated with acute respiratory distress syndrome

WHO Coronavirus (COVID-19) Dashboard. WHO Coronavirus (COVID-19) 2020

Dimensionamento dos Transplantes no Brasil

COVID-19-Associated Mortality among Kidney Transplant Recipients and Candidates in the United States

Effects of the COVID-19 Pandemic on Solid Organ Transplantation During 2020 in Poland Compared with Countries in Western Europe, Asia, and North America: A Review

COVID-19 pandemic and worldwide organ transplantation: a population-based study

An International survey on living kidney donation and transplant practices during the COVID-19 pandemic

PMID: 33245844; PMCID: PMC7744917. patients in the COVID-19 pandemic era: a systematic scoping review

Mortality among solid organ waitlist candidates during COVID-19 in the United States

Table 01 -Pre vs During COVID-19 activity on Donation and Transplantation in