Four weeks ago, I strolled into Manhattan Eye, Ear, and Throat Hospital to a ghost waiting room. All the trappings of a normal outpatient hospital were there: TVs blaring cable news, taupe-coloured chairs, fake plants. But where patients and their loved ones would usually be waiting, there was just one solitary person.
I was here as one of the last elective surgeries on the docket at Northwell Health, a network of hospitals that employs 68,000 across New York state. My knee was basically a ticking time bomb, owing to a fragment of bone dislodging from femur and scraping up my cartilage. My doctor warned that it could pop loose at any moment, putting me at risk of needing emergency transplant surgery at the height of the pandemic if I didn’t get it taken care of now.
It felt like a bit of a trolley problem in terms of resources like personal protective equipment, staff time, and safety. But even as Northwell cancelled most elective surgeries, I was left on the schedule owing to my “grey area” status (not exactly a status you want in terms of medical maladies). The procedure—dubbed an allograft—went as planned, with my orthopedist clearing out the loose fragment and damaged cartilage and plopping in a perfectly sized piece of donor bone and cartilage in its place. I woke up in the recovery area as the only patient and was given a couple graham crackers and a tiny can of ginger ale, a meal I informed my wife was “the best fucking meal ever” when she showed up (turns out anesthesia makes you a little less inhibited). They discharged me shortly after into what has become a world that changes if you look away for 10 minutes.
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I was lucky to get in under the wire for my surgery. But thousands of other people have had their elective surgeries cancelled. Elective surgery is a catch-all term that can cover everything from my allograft to people waiting for a new kidney, cornea, and even certain kinds of cancer treatment like mastectomies. With the coronavirus stretching hospital resources thin, elective surgeries have gone on hold in many places (which, in a weird twist, is also crippling many hospitals financially).
That has impacts both on patients waiting for surgery and, in the case of organ, tissue, and bone transplants, the donor banks and systems in place to facilitate them. Despite a rapid outpouring of research, much is still unknown about coronavirus transmission, which means donor banks and other programs that encourage living donation have had to be stringent about screening donors and who can receive a transplant. The pandemic has slowed both viable supply as well as demand.
The United Network for Organ Sharing (UNOS), which oversees the U.S. organ transplant system, notes on its coronavirus page that whether the virus is transmissible through organ transplants “is not known at the time.” That’s hardly comforting, though the American Society of Transplantation has said the risk of coronavirus transmission via organ donation is “low.” Still, UNOS has tracked a major decline in both harvesting organs as well as demand, with medical operations focused on coronavirus response.
For my knee, the donor part had to match up to my dimensions. My doctor told me the process of finding a suitable donor could take six to 12 weeks under normal circumstances, which is partly why he recommended I go through with my surgery even as other elective surgeries were cancelled. If I didn’t take the bone they were offering, there was no telling when the next matching donation would come in.
The cartilage still had to be alive to be plopped into my dinged-up knee, and grafts like it are viable for roughly four weeks after they are taken from the donor’s body. Keith Byers, the director of distribution and marketing at JRF Ortho, told Earther that the risk of coronavirus transmission via bone transplantation is very low, but there are plenty of unknowns. As a result, JRF Ortho—the company that harvested the graft now in my knee—has taken serious precautions.
“We have put it on hold,” Byers said, speaking about harvesting grafts.
With demand also dropping, JRF Ortho has basically nowhere to send the grafts it harvested before the pandemic intensified in the U.S. Byers said they’re sending them to medical schools for students to study and work with, to ensure they aren’t wasted.
For other types of living tissue, the issues posed by coronavirus are even greater. For cornea transplants, the window of viability is about 14 days, though John Lohmeier, the executive director of Rocky Mountain Lions Eye Bank, said most doctors prefer to do the transplant within seven days. He said the best available science shows coronavirus can be transmitted via the mucous membrane in your eyes, which means it’s likely transmissible via cornea transplant and other eye-related procedures. That’s led the bank to screen donors even more thoroughly, on top of what was already a rigorous process.
“We have decreased the donor operation side of our organisation to about 8 per cent of normal right now,” Lohmeier told Earther. “We’ve had to basically shut down and not recover a lot of donors because we don’t have anywhere to send [donations]. We’re doing a few a week right now for international clients. We’re maintaining a supply of tissue in house in case there’s an emergency request in our service area.”
In the case of eyes, an emergency means an eye-saving surgery that’s considered non-elective. Sight-saving surgery, on the other hand, is considered elective, despite it sounding like something pretty essential. The medical definition of “essential” is perhaps the most jarring thing I learned during my ordeal and research for this story. Having a ticking time bomb in my knee sure felt like the surgery was essential, but at the end of the day, I would’ve been more or less able to go on with my life for a few more months if they hadn’t found a donor match.
There are obviously people in much worse shape than me who are coping with much more in the middle of a pandemic and unable to get the surgeries they need. For people with failing kidneys, getting a transplant in some cases can be considered elective, since dialysis can replicate what healthy kidneys can do, albeit with much more stress on the body. That means people seeking a kidney transplant are out of luck in some cases and, in the worst scenario, could become bystander casualties of the pandemic.
“Even now, if you have a living donor, there’s nothing they can do for you,” Shelley Spector, the director of social work services at the Living Bank, which helps set up living organ donation, told Earther. “The longer you’re on dialysis, the more at risk you are of not living very long.”
Just because millions of Americans are staying home doesn’t mean that demand for elective surgeries suddenly stops. Living organ donation, which includes living people donating a kidney or part of their liver to someone in need, won’t necessarily be an issue once elective surgeries can begin again. Lohmeier said that, at least in Colorado and Wyoming, the supply of eye donors shouldn’t be too big a concern, since the states have some of the highest rates of opt-in organ donation in the country.
But for people waiting on donations of hearts and other transplants that can’t be done through live organ donation, the wait could be much longer. Byers said they normally have 200 people on the waiting list for allografts and pick up about 50 more patients each week. When they’re able to return to full operations, organ banks and companies will be challenged to meet the backlog of demand. It’s yet another way coronavirus is upending the U.S. medical system, one that will reverberate well after the lockdowns are lifted.