Organ donation in Australia dived by 12 per cent last year, with the COVID-19 pandemic taking a toll on the number of life-saving transplant procedures undertaken throughout the country.
The number of donors dropped from 548 in 2019 to 463 in 2020, a drop of 16 per cent. But the number of people who received transplants was 1270 last year, down 12 per cent from 1444 in 2019.
Kidney transplants for adults were paused for almost two months as Australia grappled with COVID-19 and the expected stress on the hospital system in the early days of the pandemic.
The most significant drop in the number of donors and of recipients occurred in March, April and October.
Border restrictions, reduced flights, limited access to hospitals and a smaller pool of donors contributed to making 2020 an incredibly difficult year for the DonateLife teams responsible for dealing with families, matching donors and recipients and transporting organs.
Chief executive of the Organ and Tissue Authority Lucinda Barry described the year as "extremely challenging" for staff, who were in some cases forced to have discussions with families about organ donation over video calls, due to restrictions on travel and visitors to hospitals.
"To be an organ donor you need to die in an hospital usually in [the Intensive Care Unit], and it's normally unexpected deaths. At a family's worst possible time, to try and have an end of life conversation with a family [over Zoom]," was an added challenge, Ms Barry said.
In Australia, people must register as willing donors with the government, but the final decision was made by their family, who were able to decide against donation even if someone was registered.
"The DonateLife teams have gone over and above to make sure that donation was offered to as many families as it could be, because there are people who need a transplant," Ms Barry said.
With commercial flights almost at a standstill, medical teams also faced huge challenges moving organs if a match was found interstate. In one case, when there was no flight and a border was closed between two states, one team drove an organ to the border and exchanged it with another team, which then drove it to the capital city for the procedure.
In another case, one state refused entry to a medical team from another state due to their closed border. In that situation, a team from a third state travelled to collect the organ and ensure the transplant was made. Ms Barry said despite these hurdles, no transplant was cancelled because of the logistical issues.
"To minimise the impacts, our DonateLife teams worked hard with transplant teams to navigate the challenges facing hospitals and with logistics - including with COVID-19 restrictions, flight reductions and border closures - so that patients received the best possible outcome," she said.
"I couldn't be more proud of the DonateLife team and the work they have done to do this because it hasn't been easy in any way to do that."
Kidneys made up more than half of organs transplanted in Australia, but there were 153 fewer transplants in 2020 than the year before. Lung and liver transplants were also down, but there were more heart and pancreas transplants than the year before.
Canberran Sanjeev Sood was one of the lucky few to receive a transplant in 2020 - a kidney - in November. Diagnosed with a kidney reflux issue as a child, Mr Sood first received a kidney donation from his sister nine years ago, before complications caused that kidney to also fail.
Mr Sood was on the waiting list for 14 months, during which time he had to have dialysis at Canberra Hospital three nights a week, and he couldn't work.
"It takes a toll on your body, it's not an ideal situation to be on dialysis," he said.
"It's not just hard on you, it's hard on your family as well, your partner."
While some people stayed on dialysis for a very long time, Mr Sood said it was a difficult time he only got through because of the support of his wife Annalisa. The difference since the transplant had been life-changing.
"I feel like I can do anything. At that point [waiting for a transplant] you're kind of stuck, you can't go away from your home for more than a day or two," Mr Sood said.
"Physically and physiologically, it makes a huge difference. It just makes you feel normal again, I'm only two months out, but I already can notice my physical and mental wellbeing, just a lot clearer and sharper. All of those things make a huge difference to what I feel like I can do with my life now."
Mr Sood only knows his donor was a male, and was "building up the courage" to write a letter to the family of his donor to say 'thank you'.
He said everyone should consider organ donation but he understood what a difficult decision it must be for families to make.
"It's the ultimate gift at the end of your life, more than almost anything else, it's something money can't buy," he said.
"It's incomparable to pretty much anything else one can do."
Ms Barry urged Australians to have the conversation with their families about organ donation
"Talk to your family about donation, if you want to be donor you need to tell your family. More now than ever we need people to consider whether they want to be an organ donor," she said.
Minister responsible for the Organ and Tissue Authority Mark Coulton said the pandemic had impacted the significant gains made in organ donation over recent years.
"Australians from all walks of life faced great challenges and adversity in 2020 and those waiting for life-changing organ transplants were no different," Mr Coulton said.
Like Mr Sood and Ms Barry, Mr Coulton emphasised donation wouldn't be possible at all without the generous decision made by Australians and their families at an awful time.
"Families have continued to show their strength and generosity in agreeing to donation, even with the added COVID-19 complexities in intensive care units," Mr Coulton said.
But the waiting list for transplants continued to grow, meaning the challenge to continue to find donors would persist, even when the hurdles created by the pandemic were taken away.
"Around 1650 Australians are waitlisted for a transplant and more than 12,000 others are on dialysis - many of whom may need a kidney transplant," Mr Coulton said.
"The best chance we have to address the challenge of a longer waitlist is to have more Australians say 'yes' to donation."