Survey of U.S. Living Kidney Donation and Transplant Practices in the COVID-19 Era

Abstract

Introduction

The scope of the impact of the COVID-19 pandemic on living donor kidney transplantation (LDKT) practices is not well defined.

Methods

We surveyed U.S. transplant programs to assess practices, strategies and barriers to living LDKT during the COVID-19 pandemic. After IRB approval, the survey was distributed 5/9/20–5/30/20 by email and postings to professional society list-servs. Responses were stratified based on state COVID-19 cumulative incidence levels.

Results

Staff at 118 unique centers responded, representing 61% of U.S. living donor recovery programs and 75% of LKDT volume in the pre-pandemic year. Overall, 66% reported LDKT surgery was on hold (81% in “high” vs. 49% in “low” COVID-19 cumulative incidence states). Thirty-six percent reported that evaluation of new donor candidates had paused, 27% reported evaluations were very decreased (>0% to <25% typical) and 23% reported evaluations were moderately decreased (25% to <50% typical). Barriers to LDKT surgery included program concerns for donor (85%) and recipient (75%) safety, patients concerns (56%), elective case restrictions (47%) and hospital administrative restrictions (48%). Programs with higher local COVID-19 cumulative incidence reported more barriers related to staff and resource diversion. Most centers continuing donor evaluations used remote strategies (video 82%; telephone 43%). As LDKT resumes, all programs will screen for COVID-19, although timeframe and modalities vary. Recommendations for pre-surgical self-quarantine are also variable.

Conclusion

The COVID-19 pandemic has had broad impacts on LDKT practice. Ongoing research and consensus-building are needed to reduce barriers, guide optimal practices, and support safe restoration of LDKT across centers.