Prospects improving for those waiting for heart transplant in pandemic, experts say

Heart transplantation is a procedure that involves the replacement of the diseased and weakened heart with a healthy donor heart, and is performed when all other treatment options have been exhausted and the heart failure progresses to severe or advanced forms. It allows patients with advanced heart failure to live longer, stay active, and maintain some of their usual routines.

From the Justine law to today

2019 has been a great year for transplants in Argentina. On July 4, Congress approved the “Justina Law” by unanimous vote in both chambers. This law establishes that all persons over the age of 18 are organ or tissue donors, unless expressly stated otherwise.

We remember the family of Justina – the 12-year-old girl who died while awaiting a heart transplant – promoting the campaign “Multiply x 7», Raise awareness of the importance of organ donation. The name of the initiative is due to the fact that a person has seven organs that they can donate (heart, lungs, liver, pancreas, kidneys, bone marrow and intestines), and can therefore provide opportunities for many more. . His moving case raised public awareness and became a real crusade for organ donation. In addition, the law strengthened the procurement system, streamlined and simplified the donation and transplantation processes.

In contrast, before this law, 42% of citizens were unwilling to donate. Today, according to official sources, only 17% express this refusal.

The Single National Central Coordinating Institute for Ablation and Implants (INCUCAI) reported that in 2019, the historic record for organ donors and transplants in Argentina was surpassed. There were a total of 883 donation processes performed which enabled 1,945 patients to access the procedure. This represented a 26% increase over the previous year..

As the doctors have warned Mirta ten, Head of the Heart Failure and Transplantation Department of the ICBA (MN 68240) and Lucrecia Maria Burgos, physician in the heart failure and transplant department of the ICBA (MN 148752), “we expected a 2020 with similar or better numbers. But the COVID-19 pandemic was a big deal for all of our patients. The number of heart transplants has decreased in all countries of the world and Argentina was no exception ”.

A study published in the scientific journal JAMA Cardiology reported that during the COVID-19 pandemic in the United States, new patients on the waiting list for heart transplants declined by more than a third. In addition, the volume of heart transplants has decreased by 26% nationwide compared to the pre-COVID-19 stage, even in areas with less circulation of the virus.

A similar scenario has occurred in Argentina. In 2020, a total of 92 heart transplants were performed. This represented a decrease of 22%. Since 2019, 118 operations have been carried out.

The reasons are multiple: decrease in the number of donors and the capacity of intensive care units to treat potential donors, concerns about COVID-19 positive donors, lack of access to COVID-19 tests to confirm the status of donor and decrease in the number of unintentional deaths as a result of social distancing policies.

Likewise, reduced heart failure hospitalizations during the pandemic led to fewer patients accessing urgent transplant assessments.

It is also important to stress the limits on the operational capacity of organ procurement teams to travel and access hospitals in different jurisdictions and the restrictions to refer patients with heart disease to very complex centers which are usually located in areas where the virus is more circulating. .

“The year 2021, on the other hand, has started off very promisingly for all of our patients. Figures provided by INCUCAI indicate that 11 heart transplants have already been performed in Argentina in January. At ICBA that month we performed three emergency heart transplants. Two of these patients were referred from other provinces. The pandemic has forced the development of demanding protocols that ensure safety in donor selection, to ensure the non-transmission of COVID-19, and measures have been put in place to overcome operational logistical difficulties, ”said Diez. and Burgos.

On the other hand, “health establishments have adapted to work safely in this pandemic. At the ICBA Instituto Cardiovascular, we are implementing an evidence-based protocol, in which we carefully assess each potential recipient of the heart to avoid performing a transplant in a patient infected with COVID-19“They added.

This includes epidemiological assessment, rapid test, RT-PCR swab, and lung imaging. Given that our institution is dedicated to the care of patients with cardiovascular diseases of varying degrees of complexity and that we do not carry out care focused on the coronavirus, the sum of the protocols of secure care within the In ICBA, those applied to the donor and the recipient help to minimize the possibility of viral transmission.

ICBA members emphasized: “we have a transplant team has high expectations for this 2021, given the commitment of the population with the donation and the great work carried out by INCUCAI. As a healthcare team, we stress the importance that patients with heart failure maintain their follow-up. Because leaving the disease uncontrolled involves a significant risk and in medical centers we can guarantee safe care ”.

The ICBA Cardiovascular Transplant Team

At the start of the transplant operation the whole center is activated, you feel the emotion and the hope in the environment – say the doctors – especially when the team goes in search of the donor organ that we are running against time, so we all begin to act harmoniously according to protocol, including surgery, residency, clinical and critical cardiology, nursing, administrative, security, operating room, laboratory, l anesthesia, bioengineering, etc.

“To provide the best possible care to our patients, we definitely need a multidisciplinary team. The team of cardiologists works permanently with doctors from other specialties such as hematology, infectology, endocrinology, pneumology, anesthesiology, among others. Every February 27, we are called together to reflect on the value of organ donation. We are working so that more and more people realize and are made aware of the importance and meaning of being a donor. Organ donation is an act of love and great generosity, a commitment in life, to live with another who needs it.. The decision to donate anonymously, voluntarily and altruistically values ​​the donor and their family, ”they concluded.

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