The “New Caledonia COVID-19 Paradox”: Dramatic indirect impact of the pandemic on organ donation and transplantation in a non-prevalence country

INTRODUCTION: With 270,000 inhabitants, New Caledonia has a very high prevalence of End-stage Kidney Disease (ESKD), with the fourth-highest globally. New Caledonia started a deceased and live-donor kidney transplantation program five years ago. On March 18th, 2020, the New Caledonian government halted all flights because of potential risk of COVID circulation. The consequences in term of ESKD patient management was significant. DESCRIPTION: The purpose was to evaluate the impact of the COVID epidemic in 2020 on the rate of kidney transplantation in an isolated country free of local COVID cases over the period of one year. METHODS: Number of Covid tests performed in the general population, number of positive tests and number of transplantation performed over the year 2020 were collected. RESULTS: An extensive screening program was implemented with an average COVID-19 RT-PCR test of 14,800 per million. Data showed that COVID-19 didn’t circulate among the population. Only a small number of imported cases were diagnosed in the context of a comprehensive screening policy and strict isolation rules. This government policy was very effective in protecting the country from the direct consequences of COVID-19, but it dramatically impacted kidney transplantation. No patient could be transplanted through the Australian and New Zealand kidney paired exchange program (ANZKX). Only 11 kidney transplants were performed in 2020 compared to an average of 23 transplants for the four preceding years, representing a nearly 50% drop in transplant activities (Fig. 1). CONCLUSION: Halting elective surgeries was deleterious on the newly-established living-donor transplant program established less than one year prior in almost complete autonomy. The reduced mobility of surgeons from expert centers in France and Australia was an essential factor. The 2020 COVID-19 pandemic protective closure measures nipped this country's local kidney transplant program in the bud.