Covid-19 protocols, reluctance hit cadaver organ donation in Karnataka

Cadaver organ donations have plummeted from 105 in 2019 to 35 in 2020, and further to 23 in the first six months of 2021 alone. Each donor can donate up to eight organs.

The donors have reduced drastically as the RT-PCR test of the body requires at least eight hours with labs having huge backlogs. On top of this, organ-specific committees in Jeevasarthakathe, the body overseeing cadaver organ transplantation in the state, are asking for repeat RT-PCR tests in the fear of getting false-negative results.

With many reports of Covid-19 patients presenting lung infection only in chest CT scans which RT-PCR tests are unable to pick up, doctors have become extra-cautious and this has further made screening for organ donation difficult and time-consuming. At the same time, organ retrieval teams have to work against the clock to ensure that the organs are still viable.

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Lijamol Joseph, Chief Transplant Coordinator, Jeevasarthakathe, told DH, "In a recent case, Jeevasarthakathe did tests thrice on a donor, and took samples from deep inside the lungs from the bronchioles to be sure of the donor's Covid-19 negative status." This when there are thousands of patients waiting for a transplant in the State.

The slow pace of organ donation is, for example, affecting 110 patients waiting for a heart transplant, 22 for heart and lungs, 1190 for a liver, 27 for liver and kidney, 3,645 for kidney, 14 for kidney and pancreas, 46 for lungs, and two patients waiting for a small bowel.

"Even if a non-Covid patient becomes brain dead days after being hospitalised, we're repeating RT-PCR tests to check if they've got hospital-acquired Covid-19 infection. Due to these extra protocols, it is adding to the routine tests we did pre-pandemic for donor screening. The advisory committee for each organ is taking extra precautions. Instead of taking a nasopharyngeal swab, they are doing bronchoscopy to check for infection.

Now, infection disease specialists are also actively involved in decision-making as they take into account the amount of exposure the donor has had to hospital settings too," Joseph said.

From these 23 donors alone this year, 56 organs and 28 tissues were retrieved (Heart - 6, Liver - 19, Kidney - 24, Kidney and pancreas - 2, Liver and kidney - 1, Small bowel - 1, Lungs - 3, Heart valves - 10, and Corneas - 18).

Grief counselling

Earlier it would take less time to convince the families of the deceased to donate organs.

"Now it is taking more time. Earlier, we would have a six-hour gap between testing the brain-dead status of the patient the first time and then the second time, then the counselling would happen and the organ retrieval would start. Now families are scared. It is difficult to convince them to donate," she said.