Cardiothoracic Organ Utilisation during the SARS-CoV-2 Pandemic in the UK

PURPOSE: The severe acute respiratory syndrome coronavirus (SARS-CoV-2) pandemic has caused widespread changes to healthcare practice. Demand on capacity, concerns for transplant recipients, including the risks of nosocomial infection, and the availability and safety of donors, lead to continuation of transplantation for only urgent and super-urgent, in-patient candidates, in the UK from March to May 2020. The aim of this study is to evaluate the impact of these practice changes on heart and lung donor utilisation during the pandemic period. METHODS: Data on all adult and paediatric heart and lung donors offered, and transplants performed, between 1 March and 30 September 2019 and 1 March and 30 September 2020 were obtained from the UK Transplant Registry. The early pandemic period is defined as 1 March to 31 May 2020. Ideal lung donors are defined as age <56 years and no smoking history. RESULTS: Lung transplant activity during the early pandemic period fell by 77% (13 transplants compared to 56 in 2019). Heart transplant activity fell by 10% (38 compared to 42 heart transplants in 2019). The number of donors, who donated at least 1 solid organ, fell by 51%. The lung donor utilisation rate during the early pandemic period was 11%, compared to 24% for the same period of 2019. The heart donor utilisation rate during the pandemic period was 35% compared to 26% during the same period of 2019. The proportion of ideal lung donors, from donors where lung(s) were offered, was 23% in 2020 compared to 24% in 2019. Following the early pandemic period (1 June to 30 September 2020), there has been an increase in the number of lung donors, lung transplant activity and utilisation, rising from 11% in March to May to 14% in June to September. This compares with a utilisation rate of 21% for the same period of 2019. CONCLUSION: During the SARS-CoV-2 pandemic, changes to practice led to the continuation of heart transplantation, with minimal impact on activity, whilst lung transplant activity fell. The number of organ donors fell, while the ‘quality’ of potential lung donors remained unchanged. As the evidence base guiding clinical practice is evolving, along with improved donor testing, lung transplant activity is again increasing, however the utilisation of donors remains lower than in 2019. On-going analysis of activity is required to fully assess the impact of the SARS-CoV-2 pandemic on the UK lung transplant population.