With revised guidelines in place, critically ill patients can continue to receive life-saving organ transplants during the COVID-19 outbreak.
In March this year, Mr Koh
Khim Teck became one of
the first patients to receive
a transplant during the
His condition took a turn for the
worse when his liver cancer stopped
responding to treatment, and a
transplant became critical. Mr Koh
was able to undergo the life-saving
procedure because of revised
transplant guidelines developed
during the disease outbreak.
A lack of viable organs and
long waitlist already make it hard
for patients to get a suitable
organ. With the virus outbreak,
the concerns of infection added
to the risks associated with a
transplant. But for SGH transplant
specialists, closing the service was
not an option.
“COVID-19 could last for
months or even one to two years.
If we do not think and plan
ahead, patients [may] fall off
the waitlist and die from disease
progression,” said Dr Jasmine
Chung, Consultant, Department of
Infectious Diseases, SGH.
To keep this essential
programme open, SGH developed
organ transplant guidelines in
February 2020. The guidelines
weigh the urgency of each case
against complications, the
severity of COVID-19, and the
current availability of resources.
For instance, living donor
kidney transplants were suspended
as patients can function on
dialysis, while deceased donor
kidney transplants resumed in
April. Transplantation for organs
such as the heart and lung, which
cannot be replaced with a viable
alternative, had continued with
certain restrictions. As of October,
both living and deceased donor
transplants for the kidney and
lung are allowed.
For a safe transplant, there
must be sufficient operating
theatres, intensive care units
(ICUs), designated transplant
wards, medical equipment, and
blood products. For patient
and staff safety, hospital-wide
heightened infection measures
were also necessary. This includes
safe distancing, enhanced personal
hygiene, adequate personal
protective equipment, and stringent
screening and testing criteria.
To reduce the risk of infection,
the donor transplant team,
which may need to travel to
another hospital to collect the
organ, is kept separate from the
recipient team that performs the
transplantation. After surgery,
patients are nursed in a single
room to further minimise the risk
of COVID-19 transmission.
While the risks of infection can be
minimised within the hospital, the
patient also faces the possibility
of being infected when he returns
home and into the community. “If
they get infected by COVID-19,
especially within the first year of
transplant, it may have a bearing
on graft survival and patient
survival,” said Dr Chung.
Based on global reports, some
70 to 80 per cent of transplant
patients infected with COVID-19
require oxygen therapy, and 20 to
30 per cent may become critically
ill, require ICU care, or succumb
to the disease. In healthy
patients, only 15 per cent of
COVID-19 infections are severe
and 5 per cent critical.
Nevertheless, patients are often
willing to take the risk. According to
Associate Professor Jeyaraj Prema
Raj, Head, SingHealth Duke-NUS
Transplant Centre, 83 per cent of
waitlisted patients in an informal
study expressed willingness to
continue with the transplantation
during the pandemic.
“The key is speaking to
patients because they are the
ones who are sick; they are the
ones who will receive the organs.
For someone who has end-stage
lung disease or end-stage liver
cancer, the potential for a change
in life is tremendous. So once
we know our patients are keen,
we physicians have to make it
as safe as possible for them,”
said Prof Prema Raj, who is also
Senior Consultant, Department
of Hepato-Pancreato-Biliary and
Transplant Surgery, SGH.
Apart from the deceased donor
liver transplant Mr Koh underwent,
SGH has also successfully
performed a living donor kidney
transplant and a deceased
donor lung transplant since the
introduction of the new guidelines.
At SGH, a transplant team is
on standby round-the-clock to
make such miracles happen for the
184 patients on the solid organ
transplantation active waitlist.