Organ transplants were slashed at the start of the COVID pandemic. But 2021 saw the most ever.

After nearly 21 hours at Detroit’s Henry Ford Hospital, Autumn Harris finally got the answer she was praying for.

The family of a man in his early 20s,  who died unexpectedly of cardiac arrest, decided to donate his organs to Gift of Life Michigan, where Harris works as a family care coordinator.

The young man’s grandmother looked at Harris with tears in her eyes and said, “I trust you with my baby.”

“Although he wasn’t able to do a lot in his life, he’ll be able to do a lot more in his death in donating,” his mother said.

The man has saved three lives through organ and tissue donation.

Harris was grateful to be with the family when they made the difficult decision in November. She remembers the start of the pandemic, when it wasn't possible to be at the hospital at all. Families weren't even permitted at their loved one's bedside. 

Without that connection, organ transplants plummeted by half.  

But the dearth didn't last for long. Last year, a record-breaking 41,354 transplants were performed, according to preliminary data from United Network for Organ Sharing, the first time the U.S. has ever exceeded 40,000 transplants.  

Dr. Matthew Cooper, president of the UNOS Board of Directors, said the organization continues to see transplantation “increase substantially." 

“There was a period of early March to the end of April (in 2020) where it was just crisis mode and nobody was doing anything,” said Jill Grandas, executive director of DCI Donor Services, which make up three organ procurement organizations in Tennessee, New Mexico, and California. “Things were pretty abysmal at that point. But in May, our donor programs quickly rebounded and transplantation began again.”

Despite obstacles created by the pandemic, a harmonious combination of technological advancements, cooperation between medical facilities and solidarity among Americans drove lifesaving transplants in 2021, experts say.

“It’s an ongoing journey, the cumulative effects of years and years of efforts from the transplant community … the transplant ecosystem,” said Dr. Marty Sellers, an organ recovery surgeon and transplant specialist at Tennessee Donor Services.

Strides in medicine have increased organ recovery from donors who die of cardiorespiratory failure, or circulatory death, known as DCD. While organs recovered after DCD are harder to transplant because of a lack of oxygen, 2021 saw a nearly 30% increase in such transplants over 2020.

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“The technology and innovation in transplant make it so that people can live as a result of getting this gift of life,” Grandas said. “It’s a miracle really.”

Researchers also learned more about coronavirus transmission and began accepting organs from COVID-19 positive donors.

A summary of data from the Organ Procurement and Transplantation Network show donors with resolved COVID-19 and a positive test 21 to 90 days after the disease onset are unlikely to transmit the infection. OPTN believes donors with a history of mild COVID-19 between 10 to 21 days after disease onset are unlikely to transmit COVID-19 to nonlung recipients.

So far, the Centers for Disease Control and Prevention has reported only three cases of donor-derived COVID-19 to lung recipients. However, there have been no cases of COVID-19 transmission to nonlung recipients.

“The circumstances now are such that COVID is not necessarily a deterrent for transplant outside of a lung recipient,” Sellers said. “A COVID positive donor is no longer viewed as risky like it was at the very beginning."

Although OPTN guidelines expanded donor eligibility, Seller said donations from COVID-19-positive patient made up only about 1% of all transplants in 2021.

Experts say transplants were also driven by close collaboration between those involved in the transplantation process during the pandemic. Organ procurement organizations doubled their efforts to reach medical facilities, and competing hospitals worked together to recover organs.  

At the beginning of the pandemic, transplant center personnel were apprehensive about going to other hospitals or accepting organs from outside recovery teams, said Dr. Julie Heimbach, director of the Mayo Clinic Transplant Center in Rochester, Minnesota.

But that changed as a lack of resources required outside help.

“We have always been cooperative, but the logistics forced us to be more cooperative during these times,” she said. “We’ve continued to prioritize access to transplants throughout the pandemic… and we try to work with how best this can be done.”

Organ procurement organizations say families were also more willing to donate their loved ones’ organs during the pandemic.

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More than 13,800 people became deceased organ donors in 2021, UNOS reported, a more than 10% increase from 2020. In May,  the weekly total of deceased donors exceeded 300 for the first time.

Of 57 organ procurement organizations, UNOS found 49 experienced an increase in donation over their 2020 total. Forty-five OPOs set all-time records for donors recovered in a single year.

“We have a lot of takers in the world but not enough givers,” Harris said. “These families are so generous to be able to think of someone else during the worse times of their lives.”

Organ procurement organizations and transplant centers say they’re proud of the work accomplished in 2021 but look forward to setting new transplantation records in 2022. More than 100,000 people in the U.S. are on a waiting list for a lifesaving organ transplant, according to OPTN data, and an average of nearly 200 people are added to the list each day.

“COVID has presented some challenges and I feel like we have met the challenge,” Grandas said. “We’re going to keep pushing, and we won’t stop until we get every person on that list transplanted.”

Follow Adrianna Rodriguez on Twitter: @AdriannaUSAT. 

Health and patient safety coverage at Paste BN is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.