The past year has certainly been eventful, particularly the months following the recent onset of the COVID-19 pandemic. The impact the pandemic has had on all of our lives has been enormous. Transplant recipients and those on waiting lists, families of potential donors, and health professionals working in the sector have all faced additional challenges.
Families who have experienced the death of a loved one during this time have had to cope with restricted hospital visiting policies and patient updates delivered remotely by phone rather than in person. Despite these difficulties, families of potential donors have continued to honour their loved one’s wishes and have generously been able to consider others in need, with consent rates remaining stable.
Transplant recipients have had to navigate different ways of receiving their ongoing post-transplant care, employing telehealth and other means to reduce their exposure to others and the risk of becoming infected. Fortunately, so far only a small number of recipients in Australia have contracted COVID-19 and all have recovered. People on transplant waiting lists will have felt particularly vulnerable. They have continued to engage with health services to receive supportive treatments, and no doubt wondered what the impact of the pandemic might mean for their chance of receiving an organ transplant.
Health professionals in the donation and transplantation sectors have worked closely to minimise (as much as possible) the impact of the pandemic on donation opportunities and access to transplantation. The early creation in March 2020 of the COVID-19 National Transplantation and Donation Rapid Response Taskforce provided a weekly forum at which donation, transplantation and infectious disease expertise could be shared.
Provision of data tracking of COVID-19 numbers, and information about the impact on hospital capacity, enabled timely, nationally consistent, and well-informed decisions to be made. Initiatives include agreed protocols for donor and recipient testing; overcoming logistics related to transportation and travel restrictions; and the careful consideration and management of the temporary suspension of living and deceased donor kidney transplant programs in late March 2020.
At this time, it was predicted that hospitals would be overwhelmed by sick people with COVID-19, and there were concerns about newly transplanted, heavily immunosuppressed recipients being exposed to the risk of infection. Life-saving heart, lung, liver and all paediatric transplant programs continued, with kidney transplantation recommencing in early May.
Staff working in the donation, transplantation and intensive care sectors have managed staffing and rostering complexities, redeployment, and adapting to new procedures and policies. For some, it has meant working remotely and adapting practices in order to keep projects on track, including through virtual meetings and other creative ways of sharing ideas and information. For others, there has been the risk of occupational exposure to infection and the need to adjust to the routine use of cumbersome extra personal protective equipment, as well as adopting new methods for patient and family care and communication.
Health care practitioners have demonstrated remarkable resilience and commitment, and have gone to great efforts to continue to optimise every donation opportunity and ensure continued access to transplantation. This has included safeguarding the free movement of surgical retrieval teams between jurisdictions and being flexible with donor surgery times so that interstate organ offers can continue in the face of limited commercial airline services.
Some of the key nationally led clinical activities and projects have continued during this time, including progress in delivering the National Professional Education Strategy. A particularly timely achievement, given the public health requirement for social distancing, has been the development of the DonateLife Coaching Program. This is a web-based, interactive program that seeks to build donation specialist skills in communicating with families about donation using real-time feedback provided by expert donation educators and communicators.
Best practices in donor referral, family communication and hospital implementation continue to evolve. The Clinical Practice Improvement Program (now in its fourth phase) has been revised, and the Best practice guideline for offering organ and tissue donation in Australia has been updated, along with the associated core Family Donation Conversation workshop. These initiatives have been revised to reflect contemporary best practice. This includes routine referral to donation services to advise on donor feasibility of a broader pool of patients approaching end-of-life care, and strengthening the collaborative model for offering donation to families with the involvement of donation specialist nurses. Data collection and reporting of adherence to these best practices has been enhanced, with routine dashboard reporting and tailored information provided regularly to DonateLife Network staff and hospitals.
Our ongoing focus and priority is to provide best practice donation services with a focus on high-quality care and support of donors and their families, and a mutual goal of helping as many Australians as possible to access the benefits of transplantation.