W*****B
发帖数: 4796 | 1 这方面的伤亡情况也很严重的
到目前还没有统计数字
正常医疗秩序的崩塌非常可怕
只能自求多福，千万别在这时候生病啊！
'A death sentence': Critically ill patients denied transplants amid
coronavirus outbreak
Without a new liver, Zach Branson might have only a month left to live.
Doctors just canceled his transplant surgery, citing concerns about the
coronavirus.
From the moment of his birth in 1987, Zach Branson has struggled with a rare
disease that causes bile to back up in his body, slowly devastating his
liver. Doctors operated when he was a newborn, but they told his parents
that the surgery could only delay the disease’s progress.
By last May, after three decades of repeated health scares and unlikely
recoveries, time was finally running out. Branson, 33, of Whitewater,
Colorado, needed a new liver, his doctors told him, and he needed one soon.
Late last month, he got the news he’d been praying for. His uncle, Troy
Branson, 45, had passed all the required tests. Doctors at the UCHealth
University of Colorado Hospital in Denver would remove part of Troy’s liver
and implant it in his nephew, potentially adding years to his life.
The transplant surgery was scheduled for March 25.
“It meant everything to me,” Branson said. “After struggling with my
health for my entire life, it felt like I was getting another chance.”
But that was before the new coronavirus began spreading widely in the United
States, upending routine life across the nation and forcing hospital
administrators to begin making difficult decisions about how best to deploy
limited medical resources. These choices could be particularly devastating
for the tens of thousands of Americans awaiting new organs, transplant
experts said.
Full coverage of the coronavirus outbreak
The outbreak has already caused serious disruptions. Doctors in some parts
of the country say an inability to quickly test potential donors for the
coronavirus has led them to decline viable organs, forcing some ailing
patients to wait longer. To avert the spread of the virus among vulnerable
patients who must take immunosuppressive drugs to prevent rejection of their
new organs, doctors have canceled most routine follow-up visits for
transplant recipients. And in anticipation of a surge of coronavirus
patients requiring beds in intensive care units, some hospitals are now
performing transplant operations only for patients who are at the most dire
risk of death.
That may mean delaying kidney transplants for patients who can get by on
dialysis, or holding off on heart transplants for those surviving on
mechanical heart pumps.
“I think this is incomparable to anything that we’ve experienced before,”
said Dr. Emily Blumberg, president of the American Society of
Transplantation, which published updated guidelines Monday to help
transplant programs deal with the coronavirus crisis. “We’ve been very
concerned always about the safety of the organ donor pool, and we pay a lot
of attention to lots of things to make that safer. This is a whole different
level of concern.”
Branson started to get nervous that his surgery might be in jeopardy when he
heard news reports about confirmed cases of COVID-19, the disease caused by
the coronavirus, in Denver and across Colorado. Then his transplant
coordinator called last week, on Friday the 13th. The operation was off, she
told him.
Without a transplant, Branson said his surgeon told him last week that he
might only have about 30 to 45 days to live. But he said the hospital
considers the surgery needed to remove part of his uncle’s liver to be
elective — and therefore nonessential.
In a statement to NBC News, Dr. Elizabeth Pomfret, the chief of transplant
surgery at UCHealth, confirmed that the hospital had suspended some
transplant surgeries.
“After careful consideration and consultation with the majority of
transplant programs across the country, UCHealth University of Colorado
Hospital is putting our living donor liver and kidney transplant program on
hold for two weeks, in keeping with recommendations reflecting the national
pandemic,” Pomfret said. “We and the remainder of the transplant community
do not believe that choosing to immunosuppress a recipient and expose a
donor to excess risk right now is in the interest of either the donor or
recipient.”
Branson said he is devastated. His sister and other family members were
initially outraged. His cousin, Kylie Drum, called the hospital’s decision
“a death sentence” and said she hated that “the rug was pulled out from
under him.” But Branson said he understood that doctors have to do what’s
best for everyone, not just him.
“We were all upset,” said Troy Branson, insisting that he’s willing to
risk being infected with the coronavirus if it means saving his nephew. “
But as it was explained to me, they’re concerned about space in the
hospital beds for people who may need it because of this virus outbreak. You
’ve got to understand that we’re small pieces in this puzzle. There’s
something much bigger going on, as well.”
As the coronavirus has spread, hospitals across the country have begun
limiting elective surgeries, disrupting the lives of thousands of people who
normally would benefit from more aggressive medical intervention. Patients
with gallstones have been sent home with painkillers, rather than scheduling
surgeries to remove their gallbladders. Some hospitals have even postponed
operations to remove cancerous tissue from early stage cancer patients, with
the goal of keeping limited ICU beds open for the anticipated surge of
COVID-19 patients with respiratory failure. People with advanced organ
failure and awaiting transplants are among the most vulnerable patients
affected.
Melissa Smith, 41, is on the waiting list for a double lung and liver
transplant at UW Medical Center in Seattle, which has been at the center of
the nation’s coronavirus outbreak. Smith, who suffers from pulmonary
fibrosis and liver disease, said the pandemic has added another level of
complexity and uncertainty to a system that’s already difficult to navigate.
She has to both avoid getting the coronavirus, and hope that the outbreak
doesn’t significantly slow the process for getting new organs. Smith, who
has two children, corresponded with a reporter via email, because her
condition makes it difficult to speak without losing her breath.
“For now I have been told by the transplant doctor to stay home and focus
on ‘living to stay alive,’” Smith wrote. “So I am tethered to my bedroom
, which fortunately I have been able to turn into a great space for healing
and passing the time with movies, reading, playing games with my kids and
visiting people through the sliding glass door of my bedroom.”
So far, the virus has not resulted in a dramatic drop in the number of
transplants performed in Seattle and surrounding areas, said Kevin O’Connor
, president and CEO of LifeCenter Northwest, a federally designated
nonprofit tasked with evaluating and procuring donor organs in the region.
Download the NBC News app for full coverage of the coronavirus outbreak
That’s in part, O’Connor said, because doctors at the University of
Washington School of Medicine have ramped up COVID-19 testing capabilities
that are not yet available for donors in other parts of the country. But O’
Connor said he expects that, as the outbreak worsens, patients will notice a
difference.
“I think it would be unrealistic to think or believe that there won’t be
some negative impact on the donor and transplantation enterprise in the
United States,” O’Connor said. “I just don’t think that’s reality based
. So what we need to do is mitigate the risks and find ways to adapt how we
do the work we do.”
O’Connor and other experts said they worry about what will happen if a
surge of COVID-19 patients leads to a shortage of ventilators in some
hospitals. In order to procure organs from donors who’ve been declared
brain-dead, hospitals must keep blood and oxygen circulating through their
bodies, often for several days, until a transplant team can arrive.
How long will hospitals be willing to keep a brain-dead patient connected to
a ventilator if there aren’t enough for the patients who are still alive?
Dr. Howard Huang, the medical director of the lung transplant program at
Houston Methodist hospital, shares that concern. But for now, he said the
primary challenge in Texas and the surrounding areas is hospitals’
inability to test donors for the coronavirus. Doctors don’t know how
dangerous it would be to transplant organs from a patient who’d been
infected with the virus, but many are afraid to risk it — especially for
lung transplant recipients.
“What really throws a wrench into things is that we don’t have, for now, a
rapid diagnostic that can guide this decision,” Huang said. “So we have
to ask, ‘Can we wait to transplant this patient?’” And you have to weigh
that against the possibility of importing COVID-19 into your center, into a
transplant unit, that would basically, in one swoop, disable your ability to
do transplants.”
Huang said it’s important for doctors to have honest conversations with
patients and let them know that the coronavirus outbreak has led to
uncertainty that could affect the timeline of when they’ll receive a
transplant.
For now, Branson said he’s taking it one day at a time. He tries to spend
as much time as possible in his backyard greenhouse garden, where in
addition to vegetables, he’s growing cannabis, to help dull his constant
pain. But some days he doesn’t have the energy. He struggles with severe
fatigue. His bones are fragile, a result of his failing liver function, and
his skin and eyes have grown jaundiced. He’s lost more than 20 pounds in
the past few months.
He’s still holding out hope that something will change and that he and his
uncle will be allowed to move forward with the transplant. Plus, there’s
still the possibility that he could receive a liver from a deceased donor,
though he knows the coronavirus crisis might also interfere with that
process.
After giving it some thought, he gave his sister the OK to begin making
alternative arrangements — just in case. On Monday, she called to make
plans for home hospice care. Branson hopes he won’t need it.
But he wants to be prepared.
“I’ve been pretty open to life and death for probably going on a decade or
more, knowing that death doesn’t necessarily mean the end of everything,”
Branson said. “Whatever is meant to be is going to be. That’s the way I’
m trying to approach this.” |
|
