Article Text

Original research
Impact of the COVID-19 pandemic on transplantation by income level and cumulative COVID-19 incidence: a multinational survey study
  1. Shaifali Sandal1,2,
  2. Allan Massie3,
  3. Brian Boyarsky4,
  4. Teresa Po-Yu Chiang4,
  5. Kednapa Thavorn5,6,
  6. Dorry L Segev3,4,
  7. Marcelo Cantarovich1,2
  1. 1Department of Medicine, Division of Nephrology, Multi-organ Transplant Program, Montreal, Québec, Canada
  2. 2Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
  3. 3Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
  4. 4Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA
  5. 5Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
  6. 6The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  1. Correspondence to Dr Marcelo Cantarovich; marcelo.cantarovich{at}muhc.mcgill.ca

Abstract

Objectives The COVID-19 pandemic significantly affected the provisions of health services to necessary but deprioritised fields, such as transplantation. Many programmes had to ramp-down their activity, which may significantly affect transplant volumes. We aimed to pragmatically analyse measures of transplant activity and compare them by a country’s income level and cumulative COVID-19 incidence (CCI).

Design, setting and participants From June to September 2020, we surveyed transplant physicians identified as key informants in their programmes. Of the 1267 eligible physicians, 40.5% from 71 countries participated.

Outcome Four pragmatic measures of transplant activity.

Results Overall, 46.5% of the programmes from high-income countries anticipate being able to maintain >75% of their transplant volume compared with 31.6% of the programmes from upper-middle-income countries, and with 21.7% from low/lower-middle-income countries (p<0.001). This could be because more programmes in high-income countries reported being able to perform transplantation/s (86.8%%–58.5%–67.9%, p<0.001), maintain prepandemic deceased donor offers (31.0%%–14.2%–26.4%, p<0.01) and avoid a ramp down phase (30.9%%–19.7%–8.3%, p<0.001), respectively. In a multivariable analysis that adjusted for CCI, programmes in upper-middle-income countries (adjusted OR, aOR=0.47, 95% CI 0.27 to 0.81) and low/lower-middle-income countries (aOR 0.33, 95% CI 0.16 to 0.67) had lower odds of being able to maintain >75% of their transplant volume, compared with programmes in high-income countries. Again, this could be attributed to lower-income being associated with 3.3–3.9 higher odds of performing no transplantation/s, 66%–68% lower odds of maintaining prepandemic donor offers and 37%–76% lower odds of avoiding ramp-down of transplantation. Overall, CCI was not associated with these measures.

Conclusions The impact of the pandemic on transplantation was more in lower-income countries, independent of the COVID-19 burden. Given the lag of 1–2 years in objective data being reported by global registries, our findings may inform practice and policy. Transplant programmes in lower-income countries may need more effort to rebuild disrupted services and recuperate from the pandemic even if their COVID-19 burden was low.

  • transplant medicine
  • COVID-19
  • health policy
  • rationing

Data availability statement

Data are available on reasonable request. Data sharing requests for deidentified data reported in this article will be considered upon written request to the corresponding author for up to 36 months following publication of this work. Data will be available subject to a written proposal, approval by an independent review committee and a signed data-sharing agreement.

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Data availability statement

Data are available on reasonable request. Data sharing requests for deidentified data reported in this article will be considered upon written request to the corresponding author for up to 36 months following publication of this work. Data will be available subject to a written proposal, approval by an independent review committee and a signed data-sharing agreement.

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Footnotes

  • Contributors SS: conceived and designed the work, acquired the data; analysed and interpreted the data; drafted the manuscript; approved the final version. BB and DLS: helped design the work; involved with data analysis, and interpretation; critically revised the manuscript, approved the final version. TP-YC and AM: involved with data analysis and interpretation; critically revised the manuscript, approved the final version. KT: helped design the work; involved with data interpretation; critically revised the manuscript, approved the final version. MC: conceived and designed the work; involved with data collection; critically revised the manuscript, approved the final version; responsible for the overall content as the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Map disclaimer The inclusion of any map (including the depiction of any boundaries therein), or of any geographic or locational reference, does not imply the expression of any opinion whatsoever on the part of BMJ concerning the legal status of any country, territory, jurisdiction or area or of its authorities. Any such expression remains solely that of the relevant source and is not endorsed by BMJ. Maps are provided without any warranty of any kind, either express or implied.

  • Competing interests DLS receives speaking honoraria from Sanofi and Novartis. SS has received an education grant from Amgen Canada. The rest of the authors have no disclosures.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.