She needs a kidney. The pandemic is in her way.
The coronavirus got to Rachel Bialer’s kidney before she could.
Earlier this year, the Port Washington, Long Island woman had hoped that a 27-year-old social worker in San Diego, Calif., might be a compatible kidney donor for her.
But surging coronavirus infections in San Diego make it unlikely the social worker will be able to donate anytime soon.
“They would have to quarantine her for two weeks” to ensure she is not infected, said Bialer, 65, who suffers from polycystic kidney disease, an inherited disease that adversely impacts kidney function. The disease occurs with greater frequency among Ashkenazi Jews. “She is not married and has no family or friends in New York,” Bialer said of her donor. “It is asking too much of a donor to have to quarantine like that. … So it’s now making it harder for me to get a transplant.”
The coronavirus pandemic has made it much harder on transplant donors and recipients. At the time the coronavirus spread to the United States in early spring, the U.S. was on track for another record-breaking year for transplants — what would have been the eighth in a row, according to the United Network for Organ Sharing (UNOS), a non-profit organization that administers the only organ procurement and transplantation network in the country.
But when the pandemic struck, the drop in transplants was precipitous. The week of March 8-15 there were 151 transplants from living donors in the U.S. The following week there were only 30.
Gradually the numbers have improved. Transplants began to increase in June and hit a high the week of July 12-19 with 900 transplants. Through June 30 of last year, there were 19,502 transplants from all donors (3,634 from living donors). Through June 30 of this year, there were 18,449 transplants from all donors (2,517 from living donors).
Noting that COVID-19 infections vary from region to region, Anne Paschke, a UNOS spokesperson, said the “transplant system has worked to make sure that when there is a deceased donor, they are able to work with organ procurement and transplant professionals around the country to make sure they can honor the gift of life and get those organs transplanted.”
But the pandemic has impacted transplants from deceased donors as well, according to Robert Berman, founder and director of the Halachic Organ Donor Society in New York.
About a month ago, he said, a man who had previously signed an organ donor card was hospitalized after having trouble breathing. Doctors put him on a ventilator, but the man died soon after. The ventilator enabled his heart to continue to beat. Since he wanted to be an organ donor, they tested him for COVID-19, and he tested positive.
“It was a real shame because he could have saved eight lives – his heart, lungs, pancreas, liver, skin and kidneys,” Berman said.
More than 155,000 Americans have died from COVID-19, and the Centers for Disease Control and Prevention is projecting that there may be as many as 27,000 more COVID-19 deaths this month. But no organs or body parts can be transplanted from any of those people because of the danger COVID-19 presents not just to the recipient but also to the surgical team, according to Dr. Lewis Teperman, director of transplantation for Northwell Health in Manhasset, New York and professor of surgery and medicine at the Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York.
Teperman said that shortly after Covid-19 was first detected in New York, a New York surgeon, the transplant donor and the recipient were all diagnosed with Covid-19 after a transplant operation was performed.
“This is an example of how a health care worker can get very sick,” Teperman said, declining to give more details on the incident. “The surgeon had to be intubated — and survived.”
As Covid-19 ran rampant through New York state in March and April, Teperman said “there weren’t any organ donors in April” and thus all living donor transplantation ceased.
In addition, he pointed out, “there was a shortage of PPE [personal protection equipment] and ventilators were in short supply. And then there was the risk of doing a transplant at a time of high infections – it was like one of the plagues. Hospitals were overrun with COVID-19 patients, so elective surgeries were not done. … An organ donation is truly an altruistic gift and you don’t want to put that donor in harm’s way.”
During the height of the pandemic in the Northeast, organ donations dropped 75 percent, Teperman noted. “We’re probably running at 80 percent plus now, not 100 percent,” he said.
The drop-off is the result of pandemic-caused limitations. Rabbi Josh Sturm, director of outreach for Renewal, a non-profit Orthodox organization that helps expedite kidney donations, said the pandemic has imposed new restrictions that are impacting the transplant process.
The potential donor has to test negative for Covid-19 in the weeks prior to the transplant and both the donor and recipient must test negative the day of the surgery, he said.
Events held to generate interest in kidney donations, a critical part of recruiting donors, must now be virtual. Those who would like to see if they are a match for the recipient receive a test kit with which they are asked to use a cotton-tipped stick to swab the inside of their cheek and mail it back. Bialer has such a Zoom event scheduled for August 5 (see below).
“We’ve done a lot of these events but are finding that people are more hesitant to donate because they are nervous about going to a hospital right now,” Rabbi Sturm said. “And some transplant centers across the country are closed because they are in COVID hotspots.”
Renewal, which arranged a record 119 kidney transplants last year, had arranged 25 by the time it closed in March. Since June, it has arranged for just seven transplants.
But Dr. Teperman, who is chairman of the strike force for the American Society of Transplant Surgeons, said people shouldn’t be overly concerned about contracting COVID-19 during kidney transplant process.
“Dialysis units are pretty safe, and you can continue to have [potential] recipients continue on dialysis while you wait for the number of COVID cases to decline,” he said. “And so centers are learning how to cohabitate with the virus.”
How to donate
If you are age 18 or older, you can register to be an organ donor. The best place to start is the US Health Resources and Services Administration which details many donation options. You can also register when you get a new driver’s license. Your license will display your choice.
To read more about your donation options and to dispel the many common transplant myths, click here.
For Bialer’s Zoom event on August 5, 8 p.m. the Zoom ID 832 8575 4949 and the password is 018070.