The hamletic dilemma of patients waiting for kidney transplantation during the COVID-19 pandemic: to accept or not to accept (an organ offer)?

The outbreak of COVID-19 led to a reduction in the number of organ transplant interventions in most Countries. In April 2020, at the Tor Vergata University in Rome, Italy, two patients on the waiting list for kidney transplantation (KT) declined a deceased donor's kidney offer. Therefore, between April 20 and 25, 2020, we conducted a telephone survey among our 247 KT waitlist patients. Our aim was to explore: (i) the COVID-19 diffusion among them; and (ii) their current willingness to be transplanted in case of a kidney offer from a deceased donor. Two hundred and forty-three patients participated in a phone interview. One patient had died from COVID-19. Eighty-five (35%) KT candidates would decline any kidney offer, in most cases until the end of the COVID-19 pandemic. Upon a multivariate analysis, female gender (OR=2.25, 95% CI=1.26-4.03, p=0.006), high cardiovascular risk (OR=2.33, 95% CI=1.06-5.08, p=0.034), a waiting list time <3 years (OR=0.375, 95% CI=0.15-0.95, p=0.04) and the need to be transferred to another hospital for HD (OR=2.56, 95% CI=1.10-5.9, p=0.03] were associated with such refusal. The COVID-19 pandemic led to a fear of transplantation in a third of the KT candidates. Proactive educational webinars could be a useful tool to remove, or at least lessen, any doubts on the part of KT candidates and to avoid losing the opportunity to quit dialysis.