Donation and transplantation activity in the UK during the COVID-19 lockdown

As of May 14, 2020, over 11 000 patients with COVID-19 in the UK were admitted to intensive care units (ICUs), with a median length of stay of 9 days.¹ The COVID-19 pandemic had the immediate effect of severely reducing living and deceased organ donation and transplantation activity, as happened in other countries.² On March 23, 2020, the same day that the UK Government announced lockdown restrictions, National Health Service (NHS) Blood and Transplant altered the age acceptance criteria for deceased donors to protect ICU bed capacity and maximise use of organs available for transplantation.³ The maximum age for donation after brain death was reduced from 85 years to 60 years (increased to age 75 years after April 7, 2020) and the maximum age for donation after circulatory death from 80 years to 50 years. These changes would, in ordinary times, be expected to reduce actual donor numbers by approximately 47%.³ All potential donors are required to have a negative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid test nose and throat swab and endotracheal aspirate.⁴ Many specialist nurses in organ donation were redeployed to various roles in ICUs and other COVID-19 related projects. Transplant priority was given for patients on the super urgent liver and heart transplantations lists.

We compared donor and transplantation activity during the COVID-19 lockdown period March 23 to May 10, 2020, with the same time in 2019 (appendix p 1). Compared with 2019, the number of deceased donors decreased by 66% and the number of deceased donor transplants decreased by 68%, larger decreases than we estimated.³ The number of referrals of potential donors decreased by 39%. These decreases might be because ICU physicians did not refer those not meeting the new criteria for donors but might also reflect a reduction in the potential donor pool, with a reduction in trauma and other emergency department admissions of over 50% seen in the UK during lockdown.⁵ Families continued to support donation with a 74% consent rate despite the restrictions on them visiting hospital (appendix p 1). Abdominal organ transplants, particularly kidneys, were substantially reduced during UK lockdown compared with the same period in 2019, but heart transplants, although reduced, were not as affected, and accounted for 9% of all transplants rather than 5% as in 2019. 79% of organ donors were donors after brain death in 2020 compared with 59% in 2019 (appendix p 1); however, donors after circulatory death continued to contribute to transplantation, including two successful heart transplants.

The relaxation of lockdown coincides with the first steps in donation and transplantation recovery. The upper age limit for donation after circulatory death has been increased to 60 years, three suspended renal programmes have re-opened, and many specialist nurses in organ donation have returned to their usual roles. If we must live with COVID-19 in the future, data on the morbidity and mortality due to SARS-CoV-2 infection in transplant recipients and those awaiting transplantation are needed.

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