Deceased organ donation and transplantation during COVID-19 pandemic – The Pune experience
Mrs. Arati Gokhale
Zonal Transplant Coordination Centre
It was one of the days in March 2020, everyone was happy because we had started the new year with more than10 organ donations. We were hoping that 2020 would bring new development by reaching donation in three digits. I remember I visited Nashik, Kolhapur and Satara to find out the need and appointment of new coordinator to start work under ZTCC Pune, but on 23 March the first lockdown was announced for 21 days. I was hoping that after 21 days everything would be fine and the process would be restored, but the lockdown continued. Wearing masks, social distancing, and sanitisation became the new normal.
All hospitals were working but there were no organ donations. April went silently with zero donation. By then online meetings started for setting up guidelines for allocation and distribution at the National Organ and Tissue Transplant Organisation and Regional Organ and Tissue Transplant Organisation (NOTTO-ROTTO) level. Finally, in May we all received COVID-19 guidelines by NOTTO followed by Department of Health Services. The guidelines were really challenging to implement for hospitals as well as ZTCC.
The most difficult and challenging task was to update with new COVID-19guidelines and making a strategy to implement it practically in organ allocation. How is transplant possible when you are unable to call recipients from outside the state and your city? There were restrictions on travelling. Public and private transportation had collapsed. So the first challenge was to find recipients at the local level not from intercity or intrastate even if he or she was higher up on the city waiting list (CWL). If we look at it from that patient's point of view his/her number is higher up on the CWL but he/she can't get a chance/call. It is disappointing for them, but on the other hand the local patients got the chance that they were really hoping for, to save their life and avail this unexpected golden moment in their life.
Whenever there is a donor at any centre and when you're doing multi organ and tissue donation you have to do many organ-wise investigations to ensure safety and quality of organs. Due to COVID-19 so much paperwork and investigations were added to the process, for example, all COVID-19 investigations, COVID consent form, COVID screening for health care workers, including ambulance driver, nursing staff, physicians, and surgeons. All of this increased the time of the organ donation process and that was a different challenge altogether.
We wanted to do multiorgan donations, we did not want to lose any organ because of delay, we had to implement the guidelines, we had to find out the local recipient, we had to do all investigations, and the documentation, in a limited time. All this process required so much time and that we did not have. Hospital coordinators were finding it difficult to cope and do all the extra work. So many things were going on simultaneously. It was additional stress. Everything was challenging but everyone was ready to play their role to save someone's life. And I feel that was the key point to achieve 41 deceased donations in Pune in 2020. In fact, organ donations started in Pune when COVID-19 was at a peak.
As I said earlier donations stopped in March and there were no donations in April, infact, no brain-stem death (BSD) identification or certification was done. I was thinking…how is it possible that in more than 40 centres not a single BSD identification has been done? It was possible for hospitals to identify and certify donors, but consent may not have been possible because of family refusal for COVID testing or medically unfit for donation. But no BSD identification and certification at all was not acceptable to me, especially when two months back we did 10 donations within a month and the number of BSD identifications was more than that. So I took an interest to find out the reasons behind this. There was no reason as such but COVID impact was there and some of the hospitals become COVID centres and it was obvious the all the focus got shifted to COVID. From our side a little bit of a push was required to resume the same.
In May 2020, we received guidelines from NOTTO and DHS and hospitals got an idea as to how they could go on with organ donation in the pandemic. Simultaneously online awareness programmes, webinars, interactive sessions with transplant coordinators were going on through online platforms. All the coordinators from Pune zone were charged up for donation and in May 2020 the first deceased organ donation and the first liver transplant was done in the COVID-19 pandemic. From then on organ donations started in full swing and we put in all the energy we had. At the end of 2020, 41 deceased organ donations had been done by ZTCC Pune and that was the highest number of donations in India. We shared seven organs including heart, lungs, kidney, liver all over India through ROTTO/NOTTO in 2020.
I feel proud that all my transplant coordinators from ZTCC Pune took up the challenges at every level in the process and delivered of their best for the noble cause of organ donation in this difficult situation. And most importantly I would like to salute all the deceased donor family members for giving consent to save many lives.
- Copyright © 2021. Published by MOHAN Foundation
- Keywords: Zonal Transplant Coordination Centre (ZTCC) Pune, COVID-19 guidelines, NOTTO-ROTTO, city waiting list (CWL), COVID consent form, multi organ donations