When asked how the coronavirus (COVID-19) pandemic is impacting patients in need of an organ transplant, Sridhar Tayur said there is good news and bad news on that front. Tayur is the Ford distinguished research chair and professor of operations management at Carnegie Mellon University’s Tepper School of Business, and he has been paying close attention to the subject of organ transplants during the current crisis.
"The good news is that transplants are considered critical surgeries and therefore CMS [Centers for Medicare and Medicaid Services] has given guidelines on how to keep doing them," Tayur said. "So unlike elective surgeries that, as you might have heard, are being postponed, transplant is considered a critical surgery and therefore they are not, en masse being postponed. Some transplants are, in fact taking place."
The bad news is that there are limitations on the type of transplants that can be done during this time, he explained. For example, a patient getting a kidney transplant from a living donor will have to wait until this pandemic is over, the rational being that those patients can continue to receive dialysis in the meantime.
Then there are deceased-donor transplants (liver or kidney) and that's where things get tricky, given the current healthcare crisis.
"Part of the issue is they want to make sure that both the patient and the deceased donor are COVID-19 free," Tayur said.
The problem then becomes whether or not there are test kits available to verify that neither the patient nor the donor have the coronavirus, most transplant centers will not take the risk, and therefore the surgery is likely to be postponed.
In researching this problem, Tayur said he has spoken to representatives from transplant centers at Massachusetts General in Boston, MA; the University of California, San Francisco; Johns Hopkins in Baltimore, MD; The Uintah Basin Medical Center in Roosevelt, UT; and UT Southwestern in Dallas, TX. The consensus is that living donor kidney transplants are considered elective and are therefore postponed, deceased-donor transplants are allowed but constrained by COVID-19 testing.
But the requirement of COVID-19 testing and the amount of time spent waiting for the test results brings up another significant problem. Let's say an organ donor dies in the intensive care unit (ICU) and they are a candidate for providing organs for a kidney and/or liver transplant. That donor needs to be kept on a ventilator until it is confirmed that they did not have the virus, and until the organ procurement organization surgeon can get to the hospital and remove the organs. Well, ventilators, as we already know, are in high demand these days because of COVID-19.
"So now you're bumping into the issue of should you keep this bed in the ICU and use the ventilator for this purpose, or is COVID-19 a higher priority?" Tayur said.