Delay Transplant surgery in the times of Covid-19 pandemic: Experts

Hyderabad: The World is struggling to come to terms in dealing with a pandemic of unprecedented proportion not seen in the last 100 years. All nations, from the most underdeveloped to the developed, with the most advanced and sophisticated health systems in the world are overwhelmed and are short of manpower, equipment, infrastructure and ideas to deal with the crisis added to the great economic recession that has already started to set in.

Disease trend so far has identified that the death rate from the Covid-19 flu is highest among the elderly and those with multiple other co-morbidities. There is currently very little experience and knowledge on the behaviour of Covid-19 virus in the transplanted patients. While mild infections in transplant recipients have been reported; severe infections have also occurred. Patients who have received an organ _ kidney or liver or heart _ via a transplant surgery; and are on immune-suppressive medications have low levels of immunity. So, they have higher viral loads in their body and tend to be more infective with potential spread to other individuals and the community.

Commenting on such high-risk patients, Dr. Pradheep K Rachakonda, Cardiothoracic Surgeon, Continental Hospitals said, "If you are a heart failure patient or are awaiting a transplant, you might have lot of concerns and doubts especially during this period of uncertainty. Questions like – Whether I need to continue all my medicines? Is it a good time to undergo transplant? Will I get Covid19 after I undergo transplantation? Etc. And simple response to that would be - You need to continue with all your medicines as prescribed. It is important to be regular and compliant and not skip any dosage. It is understandable in times of lockdown and with most shops closed, medicines may run out. However, all essential services are and will be open and you need to get in touch with your hospital and your Doctor and necessary arrangements can be made to procure enough supply to tide over this period."

Delayed transplant procedures better than immediate surgeries in these difficult times, transplant procedures can wait for a month or two; and it will be safest to wait to get the transplantation done after the lockdown in fully lifted. India is currently in the local transmission stage with the risk of a community spread.

For those who are awaiting transplantation, deceased donors who have been tested for the Covid-19 virus and found to be positive or who returned from Covid-19 countries or exposed to patients with confirmed or suspected Covid-19 within 14 days should not be accepted as donor at this time as per global transplantation guidelines. Also, donors who died from unexplained respiratory failure should be excluded.

In a country like India with widespread transmission, the transplantation society has recommended temporary suspension of the deceased donor program and living donor kidney and liver transplant program. Except for the most-sick patients, elective transplants should be deferred till the outbreak is under control.

Regarding travel, like all other persons, transplant recipients should adhere to travel advisories issued by their respective health authorities and government bodies. All non-essential travel should be avoided and preferably for an additional 4–6 weeks after the lockdown ceases as the virus may still be present in the community and cause delayed disease transmission. While it is a difficult and stressful period for all, it is important to rest adequately, eat nutritious food and stay positive and relaxed as there is a direct correlation between the state of mind and the immune system.