More Hospital Complications and Fewer Traffic Collisions Mean Longer Waits For Organ Donations

When Nohemi Jimenez got pregnant with her first baby, she got really tired. Way more tired than was normal, her doctors decided. They ordered tests and an ultrasound and discovered Jimenez had been born with only one kidney – and that one kidney was failing.

Jimenez was 20. She managed her health with pills and diet for the next nine years and through two more pregnancies until her doctor noticed the tired look in her eyes again. He ordered her to begin dialysis and to sign up for the waiting list for a kidney transplant.

It was strange and scary, Jimenez said, waiting for someone to die so she could live.

“It’s sitting in your mind, it just can never leave you alone,” she said. “You're just thinking about it.”

Then the coronavirus pandemic hit. California officials ordered everyone to stay at home, except to get fresh air and go to medical appointments. On day two, in March, Jimenez got in her car in San Pablo, waved goodbye to her 3-year-old son and drove to her regular Wednesday dialysis appointment.

The roads were deserted. No traffic. That meant no car accidents, she thought. She was afraid to admit what she thought next.

“I was like, ‘Oh, my God. Nobody's going to die,’ ” she said. “I'm not going to get my transplant.”

Accident deaths are the biggest source of organ donations, accounting for 33% of donations in 2019, according to the United Network for Organ Sharing, UNOS, which manages the nation’s organ transplant system under contract with the federal government.

But since the coronavirus forced Californians indoors, accidents have declined. Traffic collisions and fatalities in the state dropped by half in the first three weeks of sheltering in place, according to a study from UC Davis. Drowning deaths dropped 80% in California, according to data compiled by the nonprofit Stop Drowning Now.

Normally, in April, organ procurement organizations see a surge in donations related to outdoor, spring break-related activities and travel. But not this year.

“Spring break accidents are almost nonexistent because there’s no spring break,” said Janice Whaley, CEO of Donor Network West, which manages organ donations for Northern California and Nevada. “Beach accidents, motorcycle accidents, hunting accidents.”

This is on top of a range of other complications that have made transplants difficult during the coronavirus pandemic. Hospitals have had to scale back surgeries of all kinds to preserve scarce supplies of personal protective equipment and ventilators, and many just haven’t had the bandwidth to manage the delicate timing and complexity of organ donation, recovery, transport and transplant.

Overall, transplant surgeries across the country plummeted 52% last month, according to UNOS data.

“There's a lot of things that have to happen perfectly, and now we're in an imperfect situation where we're trying to deal with so many other things,” Whaley said.

For example, for organs to be viable for donation, people have to die or be declared brain dead while on a ventilator, so blood keeps flowing to the heart, lungs, liver and kidneys. Sometimes those people need to stay on the ventilator for two or three days while transplant teams and recipients are lined up, and then the recipients need to be on a ventilator for surgery, too.

“People were very antsy about having non-COVID-19 patients on ventilators, taking up space, where they wanted to make sure they were ready for that next patient,” Whaley said.

Many COVID-19 patients who died offered their organs for donation, but those were all declined out of the concern that recipients could become infected, she added.

There were also issues with doing proper testing of donors who did not die from COVID-19, as hospitals did not have enough testing supplies.

“So there may have been some organ turndowns that we normally wouldn't have seen,” said Dr. Chris Freise, an abdominal transplant surgeon at UCSF.

As a matter of policy, hospitals canceled virtually all organ transplants from living donors, where a spouse or other family member donates a kidney or section of their liver to a loved one in need.

“That involves bringing two patients into the hospital – the donor and the recipient – and we certainly didn't want to put donors at any significant extra risk,” Freise said. “Living donor kidney transplant ground down to almost a complete halt in most programs across the country.”

While living donations have continued to be postponed, deceased donations started to creep up slowly in mid-April.

That’s when Jimenez got her call from Freise’s team at UCSF. After three pregnancies, Jimenez’s antibody levels were about as high as they could be, which made finding a match for her very difficult, Freise said, “like a needle in a haystack.” That also put her at the top of the waiting list in case a match was found.

Jimenez's phone rang at 2 a.m. on April 17, with transplant staff telling her it was time and to get to the hospital right away.

“I was excited,” she said. “But then my mind hit me: Somebody died.”

All she knows is that the person was 19 and died in an accident in Los Angeles. Jimenez wrote a letter to the donor’s family.

“I told them that I will forever be thinking of them,” she said. “I will have him or her in my body for the rest of my life, and I will live for both of us.”

Jimenez has six months of recovery ahead of her. She says she’s looking forward to going back to work and having more energy to play with her kids.