Many deceased-donor and living-donor kidney transplants (KTs) rely on commercial airlines for transport. However, the COVID-19 pandemic has drastically impacted the commercial airline industry. To understand potential pandemic-related disruptions in the transportation network of kidneys across the United States, we used national flight data to compare scheduled flights during the pandemic versus 1-year earlier, focusing on OPO pairs between which kidneys historically most likely traveled by direct flight (High-Volume by direct Air transport OPO Pairs, HVA-OPs). Across the US, there were 39% fewer flights in April 2020 versus April 2019. Specific to the kidney transportation network, there were 65.1% fewer flights between HVA-OPs, with considerable OPO-level variation (IQR 54.7%-75.3%, range 0%-100%). This translated to a drop in median number of flights between HVA-OPs from 112 flights/week in April 2019 to 34 in April 2020 (p<0.001), and a rise in wait time between scheduled flights from 1.5 hours in April 2019 (IQR 0.76-3.3) to 4.9 hours in April 2020 (IQR 2.6-11.2) (p<0.001). Fewer flights and longer wait times can impact logistics as well as cold ischemia time; our findings motivate an exploration of creative approaches to KT transport as the impact of this pandemic on the airline industry evolves.
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