Waitlisted Transplant Candidates’ Attitudes and Concerns Toward Transplantation During COVID-19

Tan, Ek Khoon; Koh, Ye Xin; Kee, Terence; Juhari, Juhainah Binte; Tan, Teing Ee; Sim, David Kheng Leng; Ho, Aloysius Yew Leng; Krishnan, Lalitha; Tee, Ping Sing; Krishnamoorthy, Thinesh Lee; Goh, Brian Kim Poh; Tan, Ban Hock; Chung, Shimin Jasmine; Phua, Ghee Chee; Jeyaraj, Prema Raj

BACKGROUND: In solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients, coronavirus disease 2019 (COVID-19) can contribute to a severe clinical course and an increased risk of death. Thus, patients awaiting a SOT or HSCT face the dilemma of choosing between a life-saving treatment that presents a significant threat of COVID-19 and the risk of waitlist dropout, progression of disease, or mortality. The lack of established literature on COVID-19 complicates the issue as patients, particularly those with inadequate health literacy, may not have the resources needed to navigate these decisions. MATERIAL/METHODS: We conducted a standardized phone survey of patients awaiting SOT or HSCT to assess the prevalence of inadequate health literacy and attitudes toward transplant during the COVID-19 pandemic. RESULTS: Seventy-one patients completed the survey, with a response rate of 84.5%. Regardless of health literacy, most waitlisted candidates recognized that the current pandemic is a serious situation affecting their care and that COVID-19 poses a significant risk to their health. Despite the increased risks, most patients reported they would choose immediate transplantation if there was no foreseeable end to the pandemic, and especially if the medical urgency did not permit further delay. There were no differences in responses across the patient waitlist groups for heart, kidney, liver, and stem cell transplant. CONCLUSIONS: These findings can help transplant centers decide how transplantation services should proceed during this pandemic and can be used to educate patients and guide discussions about informed consent for transplant during the COVID-19 pandemic.