Asunto(s)
Enfermedades de los Conductos Biliares , COVID-19 , Monitoreo de Drogas/métodos , Enfermedad Hepática en Estado Terminal , Ketamina , Respiración Artificial/métodos , Administración Intravenosa , Anestésicos Disociativos/administración & dosificación , Anestésicos Disociativos/efectos adversos , Enfermedades de los Conductos Biliares/sangre , Enfermedades de los Conductos Biliares/inducido químicamente , Enfermedades de los Conductos Biliares/patología , Enfermedades de los Conductos Biliares/terapia , Biopsia/métodos , COVID-19/epidemiología , COVID-19/terapia , Relación Dosis-Respuesta a Droga , Duración de la Terapia , Enfermedad Hepática en Estado Terminal/inducido químicamente , Enfermedad Hepática en Estado Terminal/diagnóstico , Enfermedad Hepática en Estado Terminal/mortalidad , Femenino , Francia/epidemiología , Alemania/epidemiología , Humanos , Ketamina/administración & dosificación , Ketamina/efectos adversos , Pruebas de Función Hepática/métodos , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , SARS-CoV-2Asunto(s)
COVID-19/epidemiología , Enfermedad Hepática en Estado Terminal/cirugía , Accesibilidad a los Servicios de Salud/organización & administración , Trasplante de Hígado , Derivación y Consulta/organización & administración , Tiempo de Tratamiento , Niño , Enfermedad Hepática en Estado Terminal/mortalidad , Humanos , IndiaRESUMEN
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.
Asunto(s)
Infecciones por Coronavirus/epidemiología , Enfermedad Hepática en Estado Terminal , Recursos en Salud/tendencias , Trasplante de Hígado , Pandemias , Neumonía Viral/epidemiología , Obtención de Tejidos y Órganos , Betacoronavirus , COVID-19 , Enfermedad Hepática en Estado Terminal/mortalidad , Enfermedad Hepática en Estado Terminal/cirugía , Humanos , Cooperación Internacional , Trasplante de Hígado/ética , Trasplante de Hígado/métodos , Innovación Organizacional , Pandemias/ética , Pandemias/prevención & control , Selección de Paciente/ética , SARS-CoV-2 , Encuestas y Cuestionarios , Obtención de Tejidos y Órganos/ética , Obtención de Tejidos y Órganos/organización & administración , Obtención de Tejidos y Órganos/tendencias , Listas de Espera/mortalidadRESUMEN
COVID-19 is now a pandemic with increasing numbers of cases and deaths. In addition to the economic and social damage caused by COVID-19 outbreak prolongation, damage caused by delayed treatment of other diseases such as severe cirrhosis is also serious. We aimed to describe the effect of COVID-19 on the number of liver transplants (LT) in South Korea. The number of LT performed in Korea during the Middle East Respiratory Syndrome (MERS) outbreak, and the COVID-19 pandemic was compared with the average number of LT performed in the past 5 years. There were 108.5 cases of LT performed per month during the MERS outbreak. It was 11% lower than the average of 122.8 cases per month for the last 5 years. LDLT and DDLT decreased by 13% to 75.3 cases and by 7.5% to 33.2 cases per month during the MERS epidemic, respectively. From January to March 2020 (COVID-19 outbreak), the number of LT did not decrease significantly. The lockdown caused by COVID-19 did not affect the number of liver transplants in Korea. Establishing a safe process and procedure of liver transplantation within safe boundaries can be beneficial in reducing the side effects of lockdown and saving patients' lives.