Suspended during the first confinement, kidney transplants are maintained during the new epidemic peak. But the reality is that, in hospitals, we transplant less than before, leaving patients and doctors in worry.
- During the first confinement, 220 kidney grafts were lost.
- The intensive care units are saturated and it is impossible to prefer to allocate a bed to a brain-dead donor compared to a Covid patient who has a chance of survival.
- Dialysis weakens the health of patients and makes future transplants more uncertain.
“I’m in a waiting position”, summarizes Claude Allary, 65, waiting for a kidney transplant since July 2019. Like him, 16,000 French people are hanging on to the phone call that could change their lives. In the meantime, Claude continues his dialysis. Four-hour sessions, three times a week to purify his blood, a job that his kidney no longer does.
Not a stock that you can rebuild like this
Unlike other organs, the work of the kidney can be done by a machine. A reality that prompted health authorities to suspend these transplants during the first wave in the face of the uncertainty surrounding Covid-19. September 22, the Biomedicine Agency has issued recommendations in which she indicates the need to maintain the transplants despite the epidemic. Olivier Véran, the Minister of Health, also assured that transplants must be maintained, in the same way as cancer-related care.
This decision to interrupt kidney transplants, although justified by the vagueness that surrounded the new coronavirus SARS-CoV-2 at that time, had serious consequences for patients. During the first confinement, 220 kidney grafts were lost. “Unlike a shortage of masks, if a kidney was intended for you during the first wave, we cannot say that it is not serious and that you will be called back in two months. This person will be called back when another biologically close donor comes forward. It’s not a stock that can rebuild like that. A receiver doesn’t just lose two months, he potentially loses a lot more.”, warns Alexandre Hertig, transplant doctor at the Pitié Salpetrière hospital (Paris).
Dialysis limits the life of the graft
If the will for this second wave is to avoid reliving this situation, it complicates the deal. “The activity has not resumed as before for the simple reason that the intensive care units are saturated and it is impossible to prefer to allocate a bed to a donor in a state of brain death compared to a Covid patient who has a chance of survival”, justifies Alexandre Hertig. To avoid having to make choices, the Biomedicine Agency has asked hospitals where it is possible to set up negative Covid zones and establishments to coordinate to transfer patients if necessary. “It was expected that from September 23 the teams would organize themselves to put in place the inter-hospital agreementscontinues Magali Leo, spokesperson for Renaloo, an association of patients suffering from renal insufficiency. But today there is no trace of these organizations and it is unclear what will happen to patients..”
Although these patients are not vitally awaiting these transplants thanks to dialysis, this situation weakens their health and makes future transplants more uncertain. “The general state of health of a patient awaiting a transplant can worsen and the longer he remains on dialysis, the more the life of the transplant is limited.”, supports Magali Leo. Beyond the transplant, it is the daily life of dialysis patients that suffers. “I am very limited in my movements and my personal projects, testifies Claude Allary. Outside the pandemic period, it is almost impossible to travel. At the moment, I have real estate projects and everything is put on hold.”
The slight lull in the epidemic that is taking shape and the number of daily hospitalizations that is falling suggests an improvement in the situation for patients awaiting a transplant. “The collaboration is slowly taking shapeassures Alexandre Hertig. Discussions between hospitals have started.” If a third wave were to arrive, the nephrologist wants to be reassuring and believes that our hospitals have the capacity to take care of everyone. “In Paris, for example, the Necker hospital, which specializes in pediatrics, has already offered to free up beds to perform transplants.”
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