Organ Transplantation During the Covid-19 Pandemic

Diseases that can only be treated through organ and tissue transplantation are among the serious health problems threatening life. While the progression and treatment stages of these conditions signal an anxious period for patients, the addition of the coronavirus pandemic to this situation is observed to further increase anxiety levels. Some patients do not want to go to the hospital despite experiencing various problems, while others abandon their treatment process midway. This can lead to more serious consequences and life-threatening risks. Prof. Dr. Koray Acarlı, Head of the Organ Transplantation Center at Memorial Şişli Hospital, explained what people are curious about regarding organ transplantation during the Covid-19 pandemic for Organ Donation Week, which runs from 3-9 November. Organ donation is the act of a person, during their lifetime, through their own free will, bequeathing some or all of their organs to be used in the treatment of other patients after their death. Anyone over the age of 18 and of sound mind can donate organs. Donating organs is also equivalent to giving life to another person. However, organ donation in our country is insufficient. While our country struggles with organ donation deficiency on one hand, on the other hand it has attempted to fill this gap with another source such as living donor organ transplantation and has been very successful in this regard.

Many patients are concerned about transplantation during the coronavirus period

This year, as in other sectors of the health system, coronavirus concerns are being experienced in organ transplants that normally proceed as routine. It is known that those who will undergo organ transplantation are considered critically ill patients and that the transplant is life-saving for them. However, many patients approaching the transplantation stage carry concerns about contracting coronavirus in hospitals. On the other hand, since the subject is related to the immune system, transplant recipients are also wondering whether they are at greater risk due to the medications they use. Organ transplant patients should know that they can safely undergo transplantation if necessary precautions are taken. On one hand, the Ministry of Health continuously establishes updated rules to be followed, while hospitals and Organ Transplantation Centers increase safety to the highest level with additional measures they take. During this process, PCR and antibody tests are performed on both recipients and donors, and they are admitted. After a quarantine period, tests for coronavirus are repeated and transplants are performed if no problems arise at these stages. In this sense, living donor transplants are more controlled transplants in terms of quarantine, testing and precautions. However, considering that diseases could be transmitted with organs obtained from cadavers, their tests must absolutely be performed. It should not be forgotten that organs that test negative may be infectious.

Are transplant patients at risk, do special precautions need to be taken?

There is no data showing that transplant recipients are at increased risk compared to other segments of society. The effect of immunosuppressive drugs used in this regard is not yet known. However, unlike some drugs used to suppress the immune system (cortisone), it is observed that they are used to suppress the event during severe stages of the disease (cytokine storm).

The greatest concern is becoming more ill

During the Covid-19 process, many patients have undergone organ transplantation. Because immunosuppressive drugs are used, patients may be more anxious due to coronavirus. The reason for this is the fear of becoming more ill. While theoretically this would be expected, research conducted does not suggest that organ transplant patients are at greater risk. A survey was conducted by Memorial Şişli Hospital's Organ Transplantation Center among 584 patients. As of June, liver patients visiting the center were asked whether they had contracted coronavirus. Only 4 out of 584 patients, or 0.7%, tested positive for Covid-19. The results showed no patient deaths. The conclusion reached in research on this topic worldwide is similar.

Medications must be used regularly, do not act without consulting a physician

In transplant recipients or patients who will undergo transplantation, the general view in terms of precautions is that mask use, attention to social distance, and personal hygiene measures should be applied. However, it must be remembered that dose adjustments of medications may be needed in transplant patients admitted to hospital due to Covid-19 infection. Additionally, medications recommended by the Organ Transplantation team must be taken at the recommended time and dose. No additional medication should be taken without consulting the Organ Transplantation team. It is extremely important for organ transplant recipients or patients who will undergo organ transplantation to use their medications correctly and as recommended, both against Covid-19 and to protect their general health.

Organ transplant numbers increased by 6% compared to 2017

According to the latest statistics reported by the World Health Organization, in 2018, a total of 146,840 solid organ transplants were performed, including 95,479 kidneys, 34,074 livers, 8,311 hearts, 6,475 lungs, 2,338 pancreases and 163 small intestines. These figures are from 86 member countries and represent approximately 75% of the world population. Although there was approximately a 6% increase in numbers compared to 2017, this meets approximately 10% of the world's organ transplant needs.

We rank second worldwide in living donor liver transplantation

The most common organ transplants performed in our country are liver and kidney transplants. As of 2019, in our country, 1,776 liver transplants were performed in 49 liver transplant centers and 3,863 kidney transplants in 76 kidney transplant centers. 75-80% of these transplants are from living donors. Turkey has ranked second after South Korea for years in living donor liver transplantation per million population. Memorial Şişli Hospital has also pioneered important firsts in organ transplantation. In addition to being the first private hospital to perform organ transplantation, it has been a source of hope for hundreds of families in both liver and kidney transplants. With 1-year survival rates of 86% and 10-year survival rates of 75% in liver transplantation, it is among the world's successful centers. In addition, it is one of the rare centers capable of performing transplants in pediatric patients from 4-5 months of age. In pediatric patients, 1-year survival is 85% and 10-year survival is 80%.