“It's serious because these are patients who risk dying while they're on the waiting list,” Johan Nilsson, a professor in thoracic surgery at Skåne's University Hospital, told the TT newswire.
Tens of thousands of operations have been cancelled in Sweden in order to allow the healthcare sector to cope with high numbers of seriously ill coronavirus patients. An investigation by Swedish radio shows that the average waiting time for planned operations has increased by three months since the start of the outbreak.
Many of the cancelled procedures were routine and low-risk, but even transplants of essential organs have been affected.
According to the Swedish Transplant Association, there was a 21 percent reduction in organ donors during spring, compared to the average for the same period over the past three years.
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“To me, it's surprising that the fall is quite so large. We see a decline in above all thoracic surgery, with almost 50 percent,” said Nilsson, who is also spokesperson for the association. Thoracic surgery relates to the organs in the chest, most often the heart and lungs.
“I can only speculate, but a likely explanation is that the situation in intensive care has been strained during the pandemic. There hasn't been access to the resources needed, which means that people choose not to go through with potential donors,” Nilsson explained.
Lung transplants have fallen by 58 percent, heart transplants by 38 percent, kidney transplants by 30 percent and liver transplants by 10 percent, according to the figures.
Last year, there were 812 organ transplants in Sweden, including transplants from living and deceased donors, according to the non-profit Mer Organdonation (Mod).
The enormous pressure on intensive care during the spring — which required a doubling of capacity nationwide — may have made it harder to devote time and resources to carrying out transplants where it would have been possible.
“It meant that the available capacity for us to manage organ donations and take care of donors was probably de-prioritised,” said Lars Wennberg, a doctor at the transplant clinic at Karolinska University Hospital. “Rightly or wrongly, I don't know. Sadly, of course, but that's what happens in a tough situation.”
- 'The biggest challenge of our time': How Sweden doubled intensive care capacity amid Covid-19 pandemic
Photo: Staffan Löwstedt/SvD/TT
Nilsson says that the increase of intensive care beds was focused on Covid-19 patients, and that his department actually ended up with fewer available places.
“They haven't in principle increase the number of other intensive care places [for non-coronavirus patients]. We at thoracic intensive care had fewer places, since they moved general surgery there so that cancer surgery could be carried out,” he explained.
Even before the coronavirus outbreak, Sweden had a shortage of organs for transplants; in April there was a need for 859 organs.
The shortage can mean that patients wait longer before a transplant can be carried out, which can put them at risk.
“It's clear that it has an effect if a transplant has to wait. Above all for thoracic patients, it's already harder to find suitable organs. A longer waiting time means an increased risk of dying on the waiting list,” said Nilsson.
Now that Swedish authorities believe the country has passed the peak of the outbreak, the number of coronavirus patients in intensive care has been steadily falling and is now lower than the number of non-coronavirus patients. But as the healthcare sector works to return to a normal situation, there's still worry ahead of the summer and autumn.
“We are still waiting for a return to the normal situation when it comes to organ transplants from deceased donors. We still haven't had many,” said Lars Wennberg.
“If the epidemic and the effects it's had on intensive care will continue in summer and autumn, we don't know much about yet. If this is long-term – if organ donors can't be prioritised within intensive care – then it's a real problem,” he said.