South Africa’s four heart transplant programmes face challenging times, after a year in which transplant numbers slumped dramatically, and with ongoing uncertainty about COVID-19 vaccine treatment for donor heart recipients. This is according to a Daily Dispatch report which said that 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 report says the Organ Donor Foundation has not yet provided transplant figures for the year.
While a vaccine is keenly anticipated as the best means for immunosuppressed transplant recipients to counter COVID-19, it is not clear that all transplant recipients in South Africa will benefit from the vaccine treatment.
Groote Schuur Hospital respiratory physician Dr Greg Calligaro, a member of the state-funded hospital’s transplant programme, quoted comments by Dr Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases, to the effect that, on balance, immunosuppressed individuals should be vaccinated against COVID-19.
Although South Africa’s Health Department will procure 1.5m doses of Astrazeneca vaccine from the Serum Institute of India (SII), renamed Covishield in that country, it is not entirely clear which vaccines will ultimately be available for most South Africans, the report says. As a result, the transplant programme at Durban’s Busamed Gateway Private Hospital is not yet recommending vaccination for organ recipients.
Durban transplant surgeon Dr Rob Kleinloog said until the government confirms which vaccines will be authorised for use in the country, “we rather say [to patients] ‘stay away’ [from vaccines] until we know which one is coming to South Africa”. If it’s a live vaccine, we don’t advise they take it; if it’s a dead vaccine, we say they can take it,”
Kleinloog said.
The report says any vaccine which includes live virus cells may break through the transplant recipient’s suppressed immune system and cause the recipient to contract COVID-19.
These implications are spelt out by Dr Melinda Suchard, head of the centre for vaccines and immunology at South Africa’s National Institute for Communicable Diseases, in an October 2020 note.
The report says for people with weak immune systems, live vaccines should be avoided but non-live (inactivated) vaccines can be given. In fact, the non-live vaccines become even more important to protect the person from possible future infections,” she said.
South Africa does not have a single, uniform and legislated protocol for the various organ transplant programmes.
[link url="https://www.dispatchlive.co.za/news/2021-01-11-heart-transplant-numbers-drop-in-sa-due-to-covid/"]Full Dispatch report (subscription needed)[/link]