(CN) — Dr. Shimul Shah is used to working in a high demand, low-supply environment — like what most health care facilities are now facing.
Shah is a multi-organ transplant surgeon at the University of Cincinnati College of Medicine. During the Covid-19 pandemic, organ transplant surgeons like Shah, and the organizations that help find the donors and recipients, face even higher stakes.
With hospitals restricting access to operating rooms, airline and courier services reducing capacity and surgical teams requiring higher levels of personal protection in the operating room, organ transplants in some areas of the country are taking a serious hit during the pandemic. According to the United Network of Organ Sharing (UNOS), transplants dropped for the first time in seven years — after seven consecutive years of record numbers of transplants.
“Obviously the numbers are down,” UNOS spokesperson Anne Paschke said.
According to UNOS, the number of organ transplants in the United States dropped below the 2019 number the week of April 6, and number of living donor transplants began to drop below 2019 on March 16. In the hard-hit area of the northeastern United States, there were 235 living donor organ transplants as of April 21 — about 34% lower than one year ago.
But the week of April 20 started to show signs of growth in nationwide transplants.
“Hopefully by next week we’ll see this is becoming a trend,” Paschke said.
Since organ transplants are not elective surgery they are able to continue, but with some very new parameters.
For instance, organ and tissue transplants — and the teams that perform them — often fly commercial airlines to travel to hospitals to harvest an organ. Those organs and tissue specimens may then be flown to where the recipient lives. But with commercial airline traffic down sharply, the way transplants are performed and organs are recovered has changed. Now, rather than fly a transplant surgeon and a team to a distant locale, transplant organizations are relying on local surgical teams.
“We’re encouraging local procurement as much as possible,” Paschke said.
For Dr. Shah at the University of Cincinnati College of Medicine, the Covid-19 pandemic has brought new challenges, but also opportunities for restructuring operations.
When the novel coronavirus began breaking out in Italy and China, Shah said, “It showed we had no idea what Covid meant to transplantation. There was nowhere to read about anything on it.”
Because there was very little information on Covid and how it could be spread during the organ harvest and transplant process, “We had to peel back to doing only extremely vital transplants,” Shah said.
The coronavirus appears to spread mainly through aerosolized droplets of lung fluid, so transplant operations have changed. Surgical and support teams don’t enter the operating room until at least 15 minutes after the patient has been intubated, so that any aerosolized droplets are removed from the air, Shah explained. “We’re learning as we go,” he said.
Heart and liver transplant operations pose a high risk of aerosolization because they are much longer operations, according to Shah.
Certain transplant recipients have contracted the Covid-19 virus, Shah said, but not through the transplant itself, or in the hospital. Rather, the recipients seem to be picking it up in the community after the transplant, he said.
Ohio was one of the first states in the nation to issue stay-at-home orders, so the state has a low rate of infection, Shah said. “That has saved our state,” he said. His hospital has 80% fewer coronavirus cases than was predicted.
And it’s also led to his transplant program being able to resume operations with deceased donor transplants three weeks ago. “We’ve been able to transplant a lot of people,” Shah said.