March 19, 2020
National Kidney Foundation Urges HHS to Allow Transplant Surgeries and Dialysis Procedures During COVID-19 Outbreak
March 19, 2020—The National Kidney Foundation (NKF) announced in a letter, available online, to Secretary Alex Azar of the Department of Health and Human Services that the NKF is urging the Trump Administration to distinguish which procedures are truly elective and nonessential from procedures that have immediate, significant, and life-long benefits for patients—like organ recovery and kidney transplant as well as dialysis access procedures.
The NKF advised that without this clarification, the organizations responsible for procuring and transporting deceased donor organs to transplant centers may not be able to enter the hospital, let alone facilitate the organ recovery surgery. These delays and barriers would effectively preclude most life-saving kidney transplants for the near term.
In the announcement, Joseph Vassalotti, MD, Chief Medical Officer of NKF, commented, "We are grateful to the Administration for clarifying that transplantations are an essential surgery which can be performed safely if a hospital feels they have the staff and resources available during the COVID-19 crisis. While some may think prospective transplant patients can remain on dialysis until the threat of COVID-19 has passed, it is important to recognize that this might not be in the patient's best interest."
Dr. Vassalotti added, "We encourage the Administration to now also clarify that hospitals can proceed with dialysis access procedures for patients with kidney failure who are currently on hemodialysis using a central venous catheter and patients with advanced chronic kidney disease who are approaching dialysis. Delays in the placement of optimal hemodialysis vascular access or peritoneal dialysis catheters will increase the risk for hospitalization for these already vulnerable patients."
The NKF stated that transplant surgeries from a deceased donor are, by their nature, unpredictable and cannot be scheduled in advance. The median nationwide wait time for a kidney is 4 years, during which time a patient's health and quality of life are significantly diminished. Preliminary data from Wuhan, China suggests that hemodialysis facilities are exceptionally high-risk areas for coronavirus transmission and dialysis patients are at high risk of poor outcomes including death from infection.
According to the NKF, delay in access placement can increase a patient's risk for bloodstream infections and death. For those patients not yet on dialysis, delay in placement of vascular access may result in patients beginning dialysis in the hospital, rather than at home or in a dialysis center. This will only strain hospital resources, especially emergency room resources, as the outbreak continues.
To the extent that hospitals can balance surgical procedures as usual while still implementing any necessary preparations for the growing threat of COVID-19, NKF believes it is prudent, and in the best interest of patients, to continue with these necessary vascular access procedures, the announcement stated.