According to the United Network for Organ Sharing (UNOS), as of April 2020, there were 94,822 patients waiting for a kidney transplant; in 2019, 23,401 patients received a kidney transplant. In April alone, deceased donor kidney transplants dropped nationally by 35%, and living donor transplants dropped by 89%. This was somewhat expected, given the complex considerations around protecting the wellness of healthy living donors as well as recipients.
Although overall transplant volumes have decreased nationally, UC Health continues to transplant during the pandemic in order to save more lives for patients in the Greater Cincinnati region while taking precautions to ensure patients and the transplant team remain safe.
“Organ transplantation continues to be a beacon of hope,” says Charuhas V. Thakar, MD, professor and director of the Division of Nephrology and Kidney CARE (Clinical Advancement, Research and Education) Program at the University of Cincinnati College of Medicine.
Interestingly enough, in mid-April, UC Health transplant surgeons had the opportunity to perform three dual-organ transplants (kidney-liver, kidney-pancreas and kidney-heart) in one week, bringing hope to patients suffering from organ failure to a life with new organs.
Similar to all centers across the country, UC Health has adjusted its “routine” pre- and post-transplant processes, cautiously handled living donor transplantation, and has continued deceased donor transplantation to the extent possible.
Among the many adaptations that have been made, the role of telemedicine has been the most worthy of mention. For example, in a typical setting, immediately after a transplant, patients are seen a few times per week for several weeks. Additionally, there are clinics for pre-transplant recipient and donor evaluations, annual waitlist management, etc. For the past month, UC Health has turned almost the entire outpatient transplant clinic to be delivered via telemedicine—either by phone or video visits. “We have successfully navigated patient care needs in this delicate post-transplant period while managing and preserving our providers and workforce,” explains Amit Govil, MD, medical director of kidney transplantation at UC Health, and chief, section of transplantation in the Division of Nephrology the UC College of Medicine.
There were 183 kidney transplants performed in 2019 at UC Health. Our outreach transplant clinics improve access to care over a 200-mile radius, including several rural areas. As many as one in three transplants performed at UC Medical Center are from outreach clinics. The transplant team found it necessary to continue to remain connected with partners in the community and were able to host these important activities via virtual visits. To date, all UC Health outreach clinics are being conducted by video visits, including Dayton and Portsmouth, Ohio and Lexington and Louisville, Kentucky.
In these challenging times, transplant support group discussions have also continued virtually—connecting transplant recipients, donors and those waiting for a transplant with providers. The provider team usually consists of a nephrologist, transplant surgeon, social worker and administrative and coordinator team member. “The feedback we have received from our patients has been one of the motivating factors in delivering this important aspect of care during the COVID-19 crisis,” says Dr. Govil.
Telemedicine is not new to the UC Health transplant team. “In the Division of Nephrology, we have been used to delivering kidney care to acute care hospitals in rural regions through telemedicine over the past two years, so the transition to a different set of patients was relatively seamless for our team,” says Dr. Thakar. “It is rewarding to see that our team has exemplified and is able to provide transplant counseling as well as direct patient care inpatient homes, especially when they are feeling vulnerable and anxious due to the current pandemic. We are extremely fortunate to have a dedicated and capable team of transplant physicians, as well as the infrastructure provided by UC Health to be able to continue the momentum of our transplant program.”