Last July, Sarah Fraser learned she had two years at most before she needed to have her two failing kidneys replaced.
“I was 23 at the time—a 23-year-old was sitting in a doctor’s office in Toronto public, she was told, like, ‘You need to find a new college,'” the law student recalls. “It’s not like, ‘” You need to find a new job.”
Fraser was 14 when she was diagnosed with lupus nephritis, an autoimmune disease that affects the kidneys. She knew she would eventually need a transplant, but she never thought the time would come during a global pandemic.
But she is one of many. Hundreds of Canadians needing a new organ have seen their lives put at risk by the pandemic, as hospitals stop performing life-saving transplants and suffer from an organ shortage.
Fraser’s situation deteriorated over the winter, so a Caledon, Ont. resident started an online campaign to find living donors, as no one in her family was a match for her.
Many strangers volunteered and applied for a donation. But then the third wave hit. On April 18, the University Health Network (UHN), where Fraser was seen, stopped screening all living kidney donors.
“It was very hard to hear,” Fraser said. “I’ve spent hours and days with my friends, making this campaign and educating people and trying to really push it forward. And then it’s like ‘Roadblock: We’re not checking them.'” ”
Fraser is now stuck in limbo as she awaits her response from the show as to when things will resume.
Transplants stopped during the third wave
The third wave of COVID-19 infections was the worst in Canada; The country averaged about 9,000 new cases per day at its peak in mid-April.
This had devastating effects on Canada’s largest farming centre, the National University of Health’s Ajmera Agriculture Centre. Based at Toronto General Hospital, the center receives patients from all over the country.
He had to shut down parts of the transplant program because the hospital’s intensive care unit was so overwhelmed with COVID-19 patients that there weren’t enough nurses, dialysis resources and operating rooms available to perform the surgeries.
“We have only done the most urgent cases, which means we have actually stopped performing many kidney transplants from living donors during that time,” said Dr. Atul Homar, medical director of the center.
She also had to reject some organs from deceased donors, accepting them only if the organs were in good condition and if they felt confident that the transplant would work.
“I don’t think we should cover it with reeds: there were wasted organs,” said Homar. “There were definitely wasted organs that weren’t transplanted and that could have been transplanted.”
He said the number of people who died while waiting for a transplant had increased by 30 percent during the pandemic, calling it a “real tragedy.”
“I mean, COVID has been a terrible thing, and we know the direct damage that COVID has cost, to lives and the well-being of patients. But there is a lot of collateral damage that has occurred that hasn’t always been on the radar.”
Homar said the center also had to deal with the fact that organ donations from deceased donors declined in April and May. Usually many donations come from people who died in intensive care units, but since most of these patients had COVID-19 at the time, their organs could not be used for fear of transplanting the virus.
Furthermore, Canada usually imports some members from the United States. It stopped during the first wave – and then slowly rebounded after that.
“We typically get 30 to 40 lungs a year from the US, and we’re going to zero,” said Dr. Shav Keshavjee, director of the Toronto Lung Transplant Program, which is part of the center. “We didn’t want to send our teams there for their safety, and screening members wasn’t reassuring enough.”
Lung transplants in Ontario fell nearly 50 percent from April 2020 to March 2021, compared to the previous fiscal year.
Less impact elsewhere in Canada
Fortunately, not all transplant centers in Canada have been affected as badly as UHN.
In British Columbia, for example, lung and heart transplants set a record in 2020.
“We haven’t been severely affected,” said Dr. Sean Keenan, medical director of organ donation services in British Columbia. While BC Transplant operations slowed dramatically at the start of the pandemic, they quickly returned to normal.
Transplantation in Quebec was also affected by the first wave, with transplants in the province down 20 percent. But a spokesperson for the program said in an email that their activities had resumed to normal by the end of 2020 and had remained steady ever since.
Dr. Sonny Dhanani, co-director of Donation and Critical Care at Canada’s Donation and Transplant Research Program, said the reason these programs have improved is because intensive care units in Vancouver and Montreal have not been hit as hard as those in Toronto.
In Toronto, he said, “there was no ability to clear space.”
How does the situation compare to other waves?
The biggest drop in transplant activity in Canada came in April 2020, when the first wave peaked.
“Things are down 30 or 40 percent,” Dhanani said. “There was so much unknown with COVID that we shut everything down appropriately.”
“We were not sure if we could successfully screen the donors for COVID and make sure it was not transmitted,” Homar said. “We weren’t sure we could develop safe pathways within the hospital to make sure recipients don’t get COVID in the hospital.”
By the third wave, Homar said, staff knew that performing transplants safely during the pandemic was possible, but a lack of resources forced them to stop, which he said made it much worse than other waves.
It’s not just about surgeries
It’s not just the drop in actual transplants that has hurt those who need new organs.
Part of the damage the pandemic has done is patients receiving inadequate care – something Afsana Lalani said she has suffered. The 21-year-old nursing student suffers from a rare liver disease and is waiting to find a matching donor who can help her get the life-saving surgery she needs.
Like Fraser, Lalani’s journey began in the summer after she developed a severe liver infection. She said her health slowly deteriorated and her inability to easily see a doctor in person made matters worse.
She explained that one of the biggest symptoms of poor liver condition is jaundice.
“If we were sitting across from a table, you would be able to see the glowing yellow eyes of werewolves that I see every day. But then it wasn’t documented on my chart,” she said. “The transplant team doesn’t see that and they think I’m stable enough.”
Although she said she told them how bad it was over the phone, she said they didn’t realize how dangerous it really was. “They’re like, ‘Yeah, you see jaundice because you see yourself in the mirror every day,'” she said.
The Toronto-based youngster is still hoping for a match soon.
As COVID-19 cases continue to decline Across the country, the situation is much better. Homar said the worst has likely passed for Canada’s largest transplant center.
“Things are getting back to normal,” he said. “The transplant program is completely open, the number of organs from deceased donors is gradually increasing, and living donation is starting to return to normal as well.”
For patients like Fraser and Laney, who are still waiting to see what will happen, the same cannot necessarily be said.
“You’re constantly wondering, ‘Well, when am I going to hear something?'” Fraser said. “All this time, your anxiety creeps in because you’re like, ‘I know my kidney function is getting worse.'”
“It has made a huge impact on my mental health and frankly, like the mental health of everyone around me,” she said. “I want the next steps. I want something to look forward to, you know, ‘One step closer, one more step.’ “