The Nationwide Impact of COVID-19 on Lung Donation and Transplantation in Belgium.

SARS-CoV-2 primarily infects the respiratory tract. Consequently, lung transplantation (LTx) programs have been significantly impacted by the COVID-19 pandemic. This study aimed to summarize the impact of the pandemic on LTx in Belgium. Eurotransplant recorded lung donation and transplantation rates from January 2015 to June 2024. Recipient mortality and LTx for COVID-19 patients were reported by all Belgian LTx centers from January 2016 to June 2023. With the onset of the pandemic, lung donation rates decreased abruptly, reaching their lowest point in the 1st half of 2020 and 2nd half of 2021, with a 44% decrease. Donation rates did not recover until the 2nd half of 2023. Concurrently, annual LTx activity decreased by 20% in 2020, 19% in 2021, and 18% in 2022, subsequently recovering in 2023. Recipient mortality peaked in the 1st half of 2022, with 42% of deaths attributed to COVID-19. Three patients received LTx for COVID-19, and all survived for more than 2 years. LTx programs should prepare for future respiratory virus pandemics. The rapid implementation of evidence-based donor screening; and the reservation of intensive care and operating room capacity can safeguard LTx activity. The high risk of breakthrough infections in LTx recipients requires close follow-up and prompt treatment.