Heart Transplant Activity Plummets Across US During COVID-19.
From mid-March to mid-May, heart donor recoveries and heart transplant volume both decreased by 26% nationally, compared with the early part of 2020.
COVID-19’s greatest impact on heart transplant activity was seen in the hardest-hit Northeast part of the country, but other regions, including areas with few virus patients, also experienced significant drops in transplant activity.
All parts of the United States saw decreases in donor recovery compared with pre-COVID, and only the Northwest region saw no decrease in heart transplant volumes.
During the same period, 600 patients in need of a new heart were taken off the waitlist, representing a 75% increase in inactivations compared with earlier in the year. Of this 600, 403 (67%) were reported to be because of COVID-19 precautions.
Not surprisingly, the Northeast had the most inactivations for COVID-19 (196 patients), followed by the Southwest (81 patients), and the Great Lakes (63 patients). For context, according to the United Network for Organ Sharing(UNOS), there are currently 3131 adults awaiting a heart transplant in the US.
“The numbers of patients removed from the waitlist for COVID considerations in New York didn’t surprise me, given the changes we had to make here to manage COVID-19, but the fact that we saw these decreases across most of the country, not just in transplantation but also in donor recovery, I think speaks to the fact that there is a complex interplay in broader organ sharing and the new allocation system whereby specific practice changes in certain regions have far-reaching implications for patients waiting for organs across the country,” said Ersilia DeFilippis, MD, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center in New York City.
In a study just published in JAMA Cardiology, DeFilippis and colleagues describe national and regional trends for heart transplantation, blending transplantation data from UNOS with regional figures on COVID-19 caseloads from the US Centers for Disease Control and Prevention.
Starting March 15, UNOS allowed transplant professionals to denote if their patient inactivation was due to COVID-19 precautions. Based on this, DeFilippis and colleagues considered January 19 to March 15 the pre-COVID period and March 15 to May 9 the COVID period.
DeFilippis allowed that COVID-19 was already prevalent in some communities before this date such that some “pre-COVID” inactivations might have also been due to COVID-19 but were not registered as such.
These data are not surprising to Nader Moazami, MD, surgical director of heart transplantation and mechanical circulatory support at NYU Langone Health in New York City. His program inactivated their patients and stopped doing transplants at the end of March and did not resume normal activities until late May.