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Transplant solutions needed if Covid-19 re-escalates – IKA

A potential resurgence of Covid-19 cases should not necessarily halt kidney transplants, the Irish Kidney Association (IKA) CEO Mr Mark Murphy has urged.

During the Covid-19 crisis, Beaumont Hospital in Dublin “paused” its kidney transplant programme, as did most centres in the UK. However, Northern Ireland’s kidney transplant programme reportedly cleared almost one-third of its waiting list following a short pause.

Mr Murphy said there must be a firm contingency arrangement to allow for the possibility of continuing kidney transplants in the event of a resurgence of Covid-19. He acknowledged that Northern Irish patients’ outcomes would need to be followed closely, but he expected these would be good.

The North’s programme had the major advantage of access to a designated ‘non-Covid’ hospital to conduct transplants, noted Mr Murphy. Additionally, more donations became available to Northern Ireland as many UK centres paused their transplant lists.

On the suspension of the programme at Beaumont, Mr Murphy also acknowledged that the virus posed a serious risk to transplant patients. There had been a possibility of continuing kidney transplant in private hospitals under the State deal, but it is understood this was not taken up for safety reasons. These factors may have included lack of laminar air flow isolation beds, the Medical Independent (MI) understands.

More broadly, Mr Murphy reiterated his call for a second kidney transplanting hospital in the Irish health service, potentially in Cork University Hospital, St Vincent’s University Hospital, Dublin, or Belfast, in order to boost transplant numbers.

As previously reported in MI, the kidney transplant programme in Belfast City Hospital has extensively used extended donor criteria and donation after cardiac death (DCD) in recent years. Speaking to MI in 2019, Belfast transplant surgeon Mr Tim Brown said this had increased the risk profile of the programme but also boosted deceased donor transplant numbers with good outcomes. The programme is also a European leader in living donations.

Mr Murphy noted that Beaumont’s programme has been undertaking a consent process with patients regarding potential acceptance of more ‘marginal’ donations. The HSE’s Organ Donation Transplant Ireland office has underlined that DCD, for example, requires enhanced resourcing and infrastructure.

The IKA CEO said Beaumont’s outcomes were good and it was around the top of the European list in this regard. He said the programme was “super safe” but some patients “mightn’t get their transplant where they would in another jurisdiction”.

He suggested that Beaumont could work alongside a second designated hospital operating a programme with a different risk profile, so that overall numbers could be increased.

Mr Murphy added that the three national transplant centres in Ireland also lacked ringfenced beds and this was hampering the capacity to deliver transplants. Mr Murphy’s understanding was the hospitals were now pushing for ringfenced transplant beds in the context of Covid-19.

Meanwhile, Mr Murphy said it was not yet clear how much extra pressure would be placed on dialysis services due to kidney injury acquired through Covid-19.

However, he said the slowdown in the transplant programme would put more pressure on dialysis units. Mr Murphy added that it would be prudent to unite the dialysis and renal transplant budgets to underline the huge financial and quality-of-life impact of prioritising transplant for eligible patients.

Mr Murphy said Covid-19 infection presented a major concern to dialysis and transplant patients.

According to statistics from the HSE National Renal Office, to date, 89 dialysis and 26 transplant patients had been diagnosed with Covid-19, with 31 deaths (27 haemodialysis and four transplant patients) in the cohort.

The renal office said the supply of surgical masks to haemodialysis patients — worn from when they were collected for their treatment until they returned home — helped reduce Covid-19 infection, alongside other measures.

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