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1.
Front Public Health ; 10: 824048, 2022.
Article in English | MEDLINE | ID: covidwho-1776020

ABSTRACT

Living kidney donation is the most common type of living-donor transplant. Italian guidelines allow the living donations from emotionally related donors only after clear and voluntary consent expressed by both the donor and the recipient involved. Living donation raises ethical and legal issues because donors voluntarily undergo a surgical procedure to remove a healthy kidney in order to help another person. According to the Italian standards, the assessment of living donor-recipient pair has to be conducted by a medical "third party", completely independent from both the patients involved and the medical team treating the recipient. Starting from the Hospital "Città della Salute e della Scienza" of Turin (Italy) experience, including 116 living kidney donations, the Authors divided the evaluation process performed by the "Third-Party" Commission into four stages, with a particular attention to the potential donor. Living donation procedures should reflect fiduciary duties that healthcare providers have toward their patients, originating from the relationship of trust between physician and patient. In addition to that, the social implications are enormous if one considers the worldwide campaigns to promote public awareness about organ donation and transplantation, and to encourage people to register their organ donation decisions. The systematic process proposed here can be a tool that proactively reduces and controls the risks of coercion, organ trafficking, vitiated consent, insufficient weighting of donative choice, that could arise especially in donors involved in living kidney donation.


Subject(s)
Kidney Transplantation , Living Donors , Tissue and Organ Procurement , Humans , Italy , Kidney Transplantation/methods , Kidney Transplantation/psychology , Living Donors/psychology , Risk Assessment , Tissue and Organ Procurement/ethics
3.
Exp Clin Transplant ; 19(1): 1-7, 2021 01.
Article in English | MEDLINE | ID: covidwho-708659

ABSTRACT

The tools in our armamentarium to prevent the transmission of coronavirus disease 2019, known as COVID-19, are social distancing; frequent handwashing; use of facial masks; preventing nonessential contacts/travel; nationwide lockdown; and testing, isolation, and contact tracing. However, the World Health Organization's suggestions to isolate, test, treat, and trace contacts are difficult to implement in the resourcelimited developing world. The points to weigh before performing deceased-donor organ transplant in developing countries are as follows: limitations in standard personal protective equipment (as approved by the World Health Organization), testing kits, asymptomatic infections, negative-pressure isolation rooms, intensive care unit beds, ventilator support, telehealth, availability of trained health care workers, hospital beds, the changing dynamic of this pandemic, the unwillingness of recipients, education updates, and additional burdens on the existing health care system. This pandemic has created ethical dilemmas on how to prioritize the use of our facilities, equipment, and supplies in the cash-strapped developing world. We believe that, at the present time, we should aim to resolve the COVID-19 pandemic that is affecting a large sector of the population by diverting efforts from deceased-donor organ transplant. Transplant units should conduct case-bycase evaluations when assessing the convenience of carrying out lifesaving deceased-donor organ transplant, appropriately balanced with the resources needed to address the current pandemic.


Subject(s)
COVID-19 , Health Resources , Organ Transplantation , Tissue and Organ Procurement/ethics , COVID-19/prevention & control , COVID-19/transmission , Cadaver , Developing Countries , Humans , Risk Factors
4.
J Hepatol ; 73(4): 873-881, 2020 10.
Article in English | MEDLINE | ID: covidwho-701738

ABSTRACT

BACKGROUND & AIMS: The outbreak of COVID-19 has vastly increased the operational burden on healthcare systems worldwide. For patients with end-stage liver failure, liver transplantation is the only option. However, the strain on intensive care facilities caused by the pandemic is a major concern. There is an urgent need for ethical frameworks to balance the need for liver transplantation against the availability of national resources. METHODS: We performed an international multicenter study of transplant centers to understand the evolution of policies for transplant prioritization in response to the pandemic in March 2020. To describe the ethical tension arising in this setting, we propose a novel ethical framework, the quadripartite equipoise (QE) score, that is applicable to liver transplantation in the context of limited national resources. RESULTS: Seventeen large- and medium-sized liver transplant centers from 12 countries across 4 continents participated. Ten centers opted to limit transplant activity in response to the pandemic, favoring a "sickest-first" approach. Conversely, some larger centers opted to continue routine transplant activity in order to balance waiting list mortality. To model these and other ethical tensions, we computed a QE score using 4 factors - recipient outcome, donor/graft safety, waiting list mortality and healthcare resources - for 7 countries. The fluctuation of the QE score over time accurately reflects the dynamic changes in the ethical tensions surrounding transplant activity in a pandemic. CONCLUSIONS: This four-dimensional model of quadripartite equipoise addresses the ethical tensions in the current pandemic. It serves as a universally applicable framework to guide regulation of transplant activity in response to the increasing burden on healthcare systems. LAY SUMMARY: There is an urgent need for ethical frameworks to balance the need for liver transplantation against the availability of national resources during the COVID-19 pandemic. We describe a four-dimensional model of quadripartite equipoise that models these ethical tensions and can guide the regulation of transplant activity in response to the increasing burden on healthcare systems.


Subject(s)
Coronavirus Infections/epidemiology , End Stage Liver Disease , Health Resources/trends , Liver Transplantation , Pandemics , Pneumonia, Viral/epidemiology , Tissue and Organ Procurement , Betacoronavirus , COVID-19 , End Stage Liver Disease/mortality , End Stage Liver Disease/surgery , Humans , International Cooperation , Liver Transplantation/ethics , Liver Transplantation/methods , Organizational Innovation , Pandemics/ethics , Pandemics/prevention & control , Patient Selection/ethics , SARS-CoV-2 , Surveys and Questionnaires , Tissue and Organ Procurement/ethics , Tissue and Organ Procurement/organization & administration , Tissue and Organ Procurement/trends , Waiting Lists/mortality
5.
An Pediatr (Engl Ed) ; 93(2): 134.e1-134.e9, 2020 Aug.
Article in Spanish | MEDLINE | ID: covidwho-627455

ABSTRACT

Despite being an international reference in donation and transplantation, Spain needs to improve pediatric donation, including donation after the circulatory determination of death. The present article, a summary of the consensus report prepared by the Organización Nacional de Trasplantes and the Spanish Pediatrics Association, intends the facilitation of donation procedures in newborns and children and the analysis of associated ethical dilemma. The ethical basis for donation in children, the principles of clinical assessment of possible donors, the criteria for the determination of death in children, intensive care management of donors, basic concepts of donation after the circulatory determination of death and the procedures for donation in newborns with severe nervous system's malformation incompatible with life, as well as in children receiving palliative care are commented. Systematically considering the donation of organs and tissues when a child dies in conditions consistent with donation is an ethical imperative and must become an ethical standard, not only because of the need of organs for transplantation, but also to ensure family centered care.


Subject(s)
Organ Transplantation/methods , Tissue Donors , Tissue and Organ Procurement/methods , Child , Death , Humans , Infant, Newborn , Organ Transplantation/ethics , Pediatrics/ethics , Spain , Tissue Donors/ethics , Tissue and Organ Procurement/ethics
6.
Am J Transplant ; 20(7): 1787-1794, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-246190

ABSTRACT

In the context of a rapidly evolving pandemic, multiple organizations have released guidelines stating that all organs from potential deceased donors with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection should be deferred, including from otherwise medically eligible donors found to have mild or asymptomatic SARS-CoV-2 discovered on routine donor screening. In this article, we critically examine the available data on the risk of transmission of SARS-CoV-2 through organ transplantation. The isolation of SARS-CoV-2 from nonlung clinical specimens, the detection of SARS-CoV-2 in autopsy specimens, previous experience with the related coronaviruses SARS-CoV and MERS-CoV, and the vast experience with other common RNA respiratory viruses are all addressed. Taken together, these data provide little evidence to suggest the presence of intact transmissible SARS-CoV in organs that can potentially be transplanted, specifically liver and heart. Other considerations including ethical, financial, societal, and logistical concerns are also addressed. We conclude that, for selected patients with high waitlist mortality, transplant programs should consider accepting heart or liver transplants from deceased donors with SARS-CoV-2 infection.


Subject(s)
Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Tissue Donors , Tissue and Organ Procurement/standards , Tissue and Organ Procurement/trends , Betacoronavirus , COVID-19 , Ethics, Medical , Heart/virology , Heart Transplantation/adverse effects , Heart Transplantation/trends , Humans , Liver/virology , Liver Transplantation/adverse effects , Liver Transplantation/trends , Lung/virology , Occupational Exposure , SARS-CoV-2 , Severe Acute Respiratory Syndrome/prevention & control , Tissue and Organ Procurement/ethics , Waiting Lists
7.
Am J Transplant ; 20(7): 1795-1799, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-176126

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly become an unprecedented pandemic that has impacted society, disrupted hospital functions, strained health care resources, and impacted the lives of transplant professionals. Despite this, organ failure and the need for transplant continues throughout the United States. Considering the perpetual scarcity of deceased donor organs, Kates et al present a viewpoint that advocates for the utilization of coronavirus disease 2019 (COVID-19)-positive donors in selected cases. We present a review of the current literature that details the potential negative consequences of COVID-19-positive donors. The factors we consider include (1) the risk of blood transmission of SARS-CoV-2, (2) involvement of donor organs, (3) lack of effective therapies, (4) exposure of health care and recovery teams, (5) disease transmission and propagation, and (6) hospital resource utilization. While we acknowledge that transplant fulfills the mission of saving lives, it is imperative to consider the consequences not only to our recipients but also to the community and to health care workers, particularly in the absence of effective preventative or curative therapies. For these reasons, we believe the evidence and risks show that COVID-19 infection should continue to remain a contraindication for donation, as has been the initial response of donation and transplant societies.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Organ Transplantation/adverse effects , Organ Transplantation/trends , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Tissue Donors , Tissue and Organ Procurement/ethics , Tissue and Organ Procurement/trends , COVID-19 , Ethics, Medical , Humans , Intensive Care Units , Occupational Exposure , Personal Protective Equipment , Resource Allocation , Risk , SARS-CoV-2 , Tissue and Organ Procurement/statistics & numerical data , United States
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