Prof Elmin Steyn

Hoe werk ’n nierooplanting? Wie kwalifiseer vir een? Wat is die grootste probleem? Wat is die risiko’s en die suksessyfer? En wat van die skenker as dit ’n lewende skenker is? Marí Hudson gesels met prof Elmin Steyn, hoof van chirurgie by Tygerberg Hospitaal en die Universiteit van Stellenbosch se mediese skool. Sy is ook ’n ervare nieroorplantingschirurg wat nieroorplantings by die Christiaan Barnard Gedenkhospitaal doen.

Agtergrondinligting

ODF PRESS RELEASE 

“The impact of the SARS–CoV–2 pandemic  on the transplant health care system was abrupt, profound and unprecedented.”
Rebecca R. Goff, PhD

IMPACT: COVID–19 ON TRANSPLANTATION
90,6% reduction in deceased donor transplants in France while in South Africa live related donor transplants have come to a complete standstill. Resulting in waiting lists being dramatically increased.

COVID–19 had an immediate and devastating impact on transplant activity as the infection became more widespread throughout the world with South Africa being
the most severely affected in Africa. The overall reduction in deceased donor transplantations since the COVID–19 outbreak was 90·6% in France and 51·1% in the USA and although the exact numbers are not yet verified for South Africa, one can easily deduce that the COVID–19 pandemic impacted transplantation more devastatingly than developed
countries.

Successful organ donation relies on many factors that have to fall into place. Donor hospitals have to make a timely referral of potential donors to organ procurement
officers, who in turn, need to coordinate with intensive care units (ICUs) to undertake the necessary testing and screening measures to exclude SARS–CoV–2 and
pneumonitis caused by the virus. To complicate matters, due to the high number of COVID–19 patients being admitted has led to hospital bed, ventilator and staffing shortages with many doctors and nurses being reassigned to COVID wards making it almost impossible to realize a potential organ procurement. An even more devastating factor is a result
of hospital visitor restrictions where family members cannot be present at the hospital, which poses a significant barrier to obtaining timely donation consent from
the next of kin.

These many hurdles have led to Healthcare providers and leaders of medical institutions needing to make difficult decisions about how best to deploy limited
medical resources. These choices could be especially devastating for the thousands of patients in need of an organ transplant.

In South Africa, there is still capacity for transplant services, but it has been significantly limited by a lack of deceased donor referrals. To compound the crisis, living elective donations, which make up 50% of all transplants performed have been paused at some centres and carried out on a risk assessment basis at other centres due to the COVID–19 restrictions imposed. Thus, not only have half the transplants that would normally be carried out, decreased significantly, but it also has become incredibly difficult for deceased donations to take place. However, deceased transplantation will continue to take place in facilities that have sufficient staff and the infrastructure available.

In summary, successful transplantation is a complex process that is reliant on many factors that have been severely challenged by the COVID–19 pandemic.
 

How the media can make a difference.

The media can help address this crisis by following the formula below.

PROBLEM
A sharp increase in deaths of patients needing an urgent transplant was caused by the impact of COVID–19 in South Africa. Due to the high risk of COVID–19 infection, all live/elective transplants in South Africa were paused. Elective transplants make up 50% of the total number of transplants performed in South Africa each year. However, these patients still qualify for deceased donor transplants. Sadly, deceased donor transplants have also dramatically declined as a result of the infectious nature of COVID–19 and the impact it has on specialist services, such as ICUs.

Both live and deceased donor transplants have been severely affected creating a compounded negative outcome for patients needing urgent transplants who will
die if not immediately helped. 

SOLUTION
In South Africa, organ & tissue donor consent is already difficult to obtain because people do not feel comfortable saying yes to consent. With an intensified call to
action and a collective effort by the media to mobilize South Africans to not only register as organ & tissue donors but to also rally them to ask their friends and family to register too. We, the Organ Donor Foundation have in the past seen an increase in organ & tissue donor consent as a result of aggressive media drives. We,
therefore, know that we can – without any doubt – save the lives of patients waiting for urgent transplants and those whose life would be drastically improved through
tissue donation. The more people who register and talk to their families, the more people will be saved. The media can immediately play a crucial role in saving and improving the lives of patients urgently waiting for an organ or tissue transplant.

CALL TO ACTION
It is our collective responsibility to mobilize South Africans to urgently register as organ & tissue donors. More registrations equal more lives being saved and more lives being improved. It is an easy message that can be easily repeated every day on every program for the month of August. This is a crisis that can be addressed and it is our social duty to act today and to continue acting for the month of August to help save lives that would otherwise be needlessly lost.

How the public can make a difference.

For a transplant to take place, a donor is needed who has a matching blood type, plus meets a range of criteria such as tissue typing and antibody cross–matching, which all has to match to a recipient. This is a complex process and can often disqualify a potential donor if a matching recipient cannot be found. It is, therefore

– in the light of the COVID–19 pandemic – critical that the pool of available donors is bigger to increase the chance for a suitable match.

Now, more than ever, South Africans need to register as organ & tissue donors to increase the opportunity for transplantation. More registered organ & tissue donors will help alleviate the unusual pressure being placed by COVID–19 on transplantation.

It is easy to register as an organ & tissue donor. Simply visit www.odf.org.za. Save a life today!
FAQ
 
What impact has the COVID–19 pandemic had on the number of transplants performed?
The number of transplants performed dramatically decreased and as a result, many patients waiting for a transplant died. Many live–related donations were paused.
There has been more than a 50% reduction of deceased donors since the COVID–19 outbreak. The reality is that this equates to a 75% compounded reduction.

What impact has the COVID–19 pandemic had on the transplant waiting list?
First of all, the number of patients waiting dramatically increased, as those on the list did not receive a transplant, making way for new patients to be placed on the list. TheCOVID–19 pandemic has drastically impacted the number of transplants that could be performed and thus with fewer transplants taking place, patients desperately waiting for a lifesaving organ transplant will wait longer with many dying in the interim.

If someone passes away due to COVID–19 can their organs be donated?
No, if a person dies while actively infected by COVID–19 their organs will not be viable to be donated.


If someone passes away due to COVID–19 can their tissue be donated?
No, None of the SA Tissue Banks currently accept tissue from donors who passed away due to COVID–19 related conditions.


How long after having recovered from COVID–19 may one donate organs or
tissue?
As with all deceased donations that are not COVID–19 related, at the time of death tests will be carried out by medical professionals to determine if the organs and tissue are suitable for donation.


Will the COVID vaccine impact the ability to donate organs or tissue; is there a suggested/preferred waiting period?
Each case would be judged by medical professionals to determine viability based on test results and medical circumstances.

Has COVID–19 severely impacted the number of ICU beds available for transplantation?
Yes, and more so during the peak of the pandemic. Recipients, immediately after the transplantation, recover in ICU and this is not possible if there are no ICU beds available.

What makes the procurement of organs difficult during COVID–19?
There is limited access to hospitals making it virtually impossible for medical professionals to refer potential donors and obtain consent. This is due to the restrictive nature of isolation and protective protocol that the COVID–19 pandemic placed on medical facilities.

Has the COVID–19 pandemic negatively impacted tissue donation?
Yes! During the peak of the wave, hospitals redirect all their resources to the COVID wards resulting in elective surgeries being paused, this in turn affects tissue donation. An example would be hip replacement surgery where the patient could have donated the femoral head.

What will increase the number of transplants during COVID–19?
The larger the number of donors available, the greater the chance, that a suitable match will be found. It is therefore essential that more people say yes to organ transplantation tomake it easier for recipients to find a match.
It is also equally important to increase the number of tissue donations in order to improve the lives of patients needing a tissue transplant.

Can public participation improve the number of lifesaving transplants during the COVID–19 pandemic?
Yes, the more people that register and rally their friends and family to register will in turn lead to an increase in the number of donors.

What responsibilities does a registered organ & tissue donor have?
During COVID–19 it is our civil duty as registered organ & tissue donors to mobilize everyone we know to register as organ & tissue donors. This will in turn increase the number of transplants.

Should my family know about my wish to be an organ & tissue donor?
All registered organ & tissue donors have a responsibility of making sure that their family knows of their commitment to being an organ & tissue donor as there is a direct correlation between knowing a loved one’s wishes to saying yes to consent.

What impact has the COVID–19 pandemic had on the number of people registering as donors?
The COVID–19 pandemic has not negatively influenced the number of people registering as donors. The number of registrations has remained constant and increased during some periods.

https://www.odf.org.za/info-and-faq-s/statistics.html