**3. Access to organ transplant services during the pandemic**

The Pandemic severely affected the UK organ transplant services as the whole NHS (National Health Services) was overwhelmed in treating COVID-19 infected patients in hospitals. In order to treat the heavy influx of COVID patients into respiratory wards and Intensive & Emergency Care Units (ICUs) several speciality hospital services were suspended, and NHS staff and resources were transferred to newly created COVID wards. To ensure the safety of patients transplant centres were also closed during the 1st Lockdown (Mar-Jun 2020) phase and with very limited access during the 2nd Lockdown (Jan-March 2021) period. Our previous study demonstrated that compare to April 2019 there was 73% reduction in deceased donor (DD) transplants and 100% reduction in living donor (LD) in the April 2020 lockdown month; and it was estimated that in the 1st Lockdown quarter 904 fewer transplants were done compared to the pre-pandemic quarter (This shortfall accounted for 16% of waiting list cases) [13].

During the Pandemic period new organ transplants guidelines were implemented with respect to stopping procurement of organs from deceased donors especially those died due to COVID as well as complete suspension of live donor list. This new guideline thus has directly impacted the number of transplant procedures done during the Pandemic affected year 2020–2021. The NHS Blood and Transplant (2021) annual activity report covering the whole Pandemic affected 2020–2021 financial year has reported that due to COVID reason 5307 patients from previous years backlog on transplant lists were temporarily suspended and 4256 new patients were added on the transplant lists during 2020–2021 [14]. Compared to pre-Pandemic 2019–2020 level, 1882 (31%) less patients were newly enrolled on the transplant list with much fewer donors (DD and LD) in 2020–2021. During the Pandemic 2020–2021 number of DD fell by 400 and LD fell by 618 comparted to 2019–2020 (pre-Pandemic year); both together accounted for fall of 1014 (38.4%) donors due to the Pandemic. Consequently 815 (22%) fewer DD transplants were done during 2020–2021. Further, due to temporary suspension of backlog patients on transplant list, their waiting time regrettably got extended further by 12 months

*Perspective Chapter: Impact of COVID-19 on the Health of Ethnic Minorities in the UK… DOI: http://dx.doi.org/10.5772/intechopen.104871*

and in this process 26% excess deaths occurred whilst waiting for their transplants in the pandemic year (474 vs. 377 in 2019–2020).

The postponement and delay in transplant services have affected the Black, Asian and Minority Ethnic (BAME) patients the most. Compared to 2019–2020, from BAME background 672 (35%) less patients were enrolled; the number of donors fell by 125 (46%) {28 in DD & 97 in LD}; and as a result, 437 (36%) less patients received DD transplants during 2020–2021 [7]. Similarly, 31% excess deaths were recorded for BAME whilst waiting for their transplants in 2020–2021 (169 vs. 100 in 2019–2020). These statistics comparisons (illustrated above and shown in **Table 1**) clearly reflect that BAME patients got affected the most during the Pandemic.

Finally, the Pandemic has impacted the BAME patients unfavourably in terms of waiting time for transplant. For instance, in the pre-Pandemic year the median time to transplant a kidney was 830 days for Asian and 965 days for Black and only 640 days for white patients [13]. Black patients continued to wait almost a year longer for a kidney transplant compared to white patients. Interestingly, 35% of white patients had received their transplant within one year after being listed for a kidney transplant whereas this figure was ironically low at 19% for BAME patients [15]. Thus, due to Pandemic, closer of transplant and suspension of backlog list has resulted in disproportionately extending the wait time for BAME patients; and increased the probability of dyeing whilst waiting for transplant.

#### **4. Racism at work during the pandemic**

According to the British Medical Association the racism at workplace experienced by BAME staff in the NHS is widespread; however, a surge in such cases during the Pandemic is unfortunate. In our recently concluded online survey of racism cases experienced before and during the Pandemic by the nursing and other healthcare professionals highlights a much wider and deeper problems in such a novel organisation. It is unfortunate to record and report such racism behaviours at the NHS despite several legislations are in place. The online survey conducted during January-May 2021 recorded responses of 308 BAME nurses, midwives and other allied healthcare staff who have faced racism at their workplace any time


#### **Table 1.**

*Number of donors, transplants and waiting list in the UK, pre- & during Pandemic Financial Year for BAME & all Ethnicities.*


**Box 2.**

*Items of information collected in online survey for Nursing & Allied NHS staff.*

during their work-life and including during the on-going Pandemic period [16]. The details of information collected is shown in **Box 2**.
