South Africa’s four heart transplant programmes face challenging times, after a year in which transplant numbers slumped dramatically due to the Covid-19 pandemic.
And the second wave of the virus has put paid to transplantations in most programmes in the first quarter of 2021.
Heart transplant figures halved in 2020 from an average of about 36 per year across the country before Covid-19, due mainly to precautions within hospitals to curb the spread of the coronavirus, a reallocation of resources away from elective procedures, and a huge fall-off in the availability of donor organs.
Cardiothoracic surgeons in Cape Town, Johannesburg and Durban said transplants slowed radically or stopped completely. The Organ Donor Foundation has not yet provided transplant figures for the year.
Netcare Milpark private hospital’s Dr Martin Sussman said there had been a huge drop-off in the availability of donor hearts, with other surgeons canvassed concurring.
He said his unit had performed about 10 procedures in 2020, half of what they normally did in a year. There have been no transplants in Durban since March, said Durban transplant surgeon Dr Robert Kleinloog.
Neither Sussman nor Kleinloog anticipated performing any transplants in the next three months.
Dr Willie Koen of Christiaan Barnard Memorial Hospital (CBMH) in Cape Town said his programme did not stop transplants or mechanical device implants as to do so “will neglect my ethical duty towards a patient. However, one must weigh up the risks”.
Between his own programme and the unit at Milpark, more mechanical heart devices were implanted during 2020 than in previous years.
He did not provide the number of transplants performed or mechanical devices implanted during 2020.
Dr Susan Vosloo, also of the CBMH performed two heart transplants on congenital patients. She regarded transplant as an emergency procedure which must be performed if a donor heart became available.
State-funded Groote Schuur Hospital performed six lung transplants in 2020, cardiothoracic surgeon Dr Tim Pennel said.
Koen said the average survival time for a patient awaiting a transplant “is barely one year”, while the waiting time for a donor heart in SA also was one year. If a heart became available, that might be a patient’s only chance, even if they were stable. “He or she might not survive till a second heart becomes available.”
A patient with end stage heart failure had a moderate prognosis if they received a mechanical heart, even if they subsequently contracted Covid-19, compared to the poor prognosis of a heart receipient who contracted the coronavirus after their transplant.
“So we haven’t closed our programme but carefully consider every option available and weigh up the best treatment for a patient with end stage hear failure.”
Sussman said research showed that Covid-19 patients whose status went undetected by a test at the time of surgery had very high mortality rates.
“It’s the same for transplantation.”
– RAY HARTLE