High-immunological risk living donor renal transplant during the COVID-19 outbreak: Uncertainties and ethical dilemmas

Ho, Quan Yao; Chung, Shimin Jasmine; Gan, Valerie Huei Li; Ng, Lay Guat; Tan, Ban Hock; Kee, Terence

doi:10.1111/ajt.15949

Cited by 12 publications

(17 citation statements)

References 5 publications

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“…The majority of the urological malignancies are given high priority and the required intervention is strongly Table 3 Urology care triage and recommendation 5,11,16,22,23,29,31,32,[38][39][40][42][43][44][45]49,50 recommended. 16,23,29,31 Urological surgeries can be triaged on basis of the COVID-19 test, cancer stage, the outcomes of delaying, and the provision of alternative treatment modalities.…”

Section: Uro-oncologymentioning

confidence: 99%

Urology during COVID-19 Pandemic Crisis: A Systematic Review

Thapa

Shrestha²,

Bista

et al. 2021

Surg J (N Y)

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Background Coronavirus disease 2019 (COVID-19) has evolved as a pandemic of unimaginable magnitude. The health care system is facing a tremendous challenge to provide ethical and quality care. The transformation of the patient-based care to population-based care during the COVID-19 pandemic has raised ethical dilemma among urologists. Our objective is to explore the consensus in modified standard urology care, that can be adopted and applied during COVID-19 and similar pandemic. Methods We adopted an exploratory study design using secondary data. The data were extracted from a web-based medical library using keywords “COVID-19,” “severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2),” and “urology.” We identify and extrapolate (screening, eligibility, and inclusion) the data using PRISMA protocol, and summarize pandemic standard urology care under four main themes: (1) general urology care, (2) choice of surgical modality, (3) triage, and (4) urology training. Result We identified 63 academic papers related to our research question. The majority are expert opinions and perspectives on urology care. The common consensus is triage-based urology care and surgeries. Life or organ threatening conditions need immediate attention. Universal protective measures (personal protective equipment, safe operative environment) and protocol-based patient care are necessary to prevent and control SARS-CoV-2 infection. Conservation of the resources and its rational distribution provide an ethical basis for population-based health care during a pandemic. Informed decision making serves best to patients, families, and society during the public health crisis. Conclusion COVID-19 pandemic tends to transform standard urology practice into crisis standard population-based care. The consensus in crisis is drawn from evolving pieces of medical evidence and public health ethics. The provision of urology care during a pandemic is based on the availability of resources; severity of the disease, consequences of deferment of service, and dynamics of the pandemic.

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Section: Uro-oncologymentioning

confidence: 99%

Urology during COVID-19 Pandemic Crisis: A Systematic Review

Thapa

Shrestha²,

Bista

et al. 2021

Surg J (N Y)

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“…Kidney transplantation, nonetheless, has stood out as a procedure that may be postponed because renal dialysis is available to sustain life 2 . This concept should be refuted foremergency patients, for example, highly sensitized recipients who can receive a suitable graft or those with no access to dialysis 50 . Moreover, given the higher rate of infection and mortality in waitlisted dialysis patients, it may be prudent to hasten, rather than postpone, transplantation in most patients.…”

Section: Should Transplantation Be Halted During the Pandemic?mentioning

confidence: 99%

“…Physicians need to start paying attention to directing their patients to high quality social media platforms for patient education 56 . Logistic issues should also be taken into consideration, such as the availability of staff, venesection for monitoring progress, blood for transfusion, medications, and ICU bed vacancies 3‐6,33,50,51,57 …”

Section: Planningto Upscale and Return After Quarantine?mentioning

confidence: 99%

“…Desensitization programs requiring elective heavy immunosuppression may be postponed, although transplantation for highly sensitized patients receiving reasonably matched organs should be prioritised. Interestingly a high immunological‐risk renal‐desensitization procedure was performed under careful infection‐control procedures from a living donor to a patient with no dialysis access in Singapore during the pandemic 50 …”

Section: Planningto Upscale and Return After Quarantine?mentioning

confidence: 99%

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Transplantation in the era of the Covid‐19 pandemic: How should transplant patients and programs be handled?

Nasrallah

Osman

Elalfy

et al. 2020

Reviews in Medical Virology

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Summary Due to the Covid‐19 pandemic caused by SARS‐CoV‐2, transplant programs worldwide have been severely impacted with dwindling numbers of transplantations performed and a complete halt in several areas. In this review we examine whether SARS‐CoV‐2 infection presents differently in transplant recipients, whom and how we should test, how susceptible the transplant population is to overt infection and describe the range of outcomes. From retrieved published reports on SARS‐CoV‐2infections in 389solid organ transplant recipients reported in the literature, the overall mortality rate was 16.7% ( n = 65); however for those with mild or moderate Covid‐19 disease this was 2.9% and 2.3% respectively; conversely, for those with severe infection the mortality rate was 52.2%.We then address questions regarding halting transplantation programs during this pandemic, whether all human tissues being considered for transplantation are capable of transmitting the infection, and if we should alter immunosuppressive medications during the pandemic.

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“…These included comprehensive counselling of the donor-recipient pair and their care givers (parents) on minimising contact with the community, frequent hand hygiene, and proper masking in the 14 days prior to the admission for transplantation. 11 The donor and recipient also underwent polymerase chain reaction (PCR) testing for SARS-CoV-2 one week and one day before surgery. They were tested negative for COVID-19 and the transplant surgery was uneventful.…”

Section: Enhancing Screening For Covid-19 In Kidney Transplant Procedmentioning

confidence: 99%

Managing a Renal Transplant Programme During the COVID-19 Pandemic: Practical Experience from a Singapore Transplant Centre

Kee

Shimin

et al. 2020

Ann Acad Med Singap

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Introduction: Coronavirus Disease 2019 (COVID-19) has significantly affected the way healthcare is delivered in Singapore. Healthcare services such as renal transplantation had to rapidly adjust and meet the needs to (1) protect patients and staff, (2) ramp up, conserve or redeploy resources while (3) ensuring that critical services remained operational. This paper aims to describe the experience of the renal transplant programme at the Singapore General Hospital (SGH) in responding to the risks and constraints posed by the pandemic. Methods and Materials: This is a review and summary of the SGH renal transplant programme’s policy and protocols that were either modified or developed in response to the COVID-19 Pandemic. Results: A multi-pronged approach was adopted to respond to the challenges of COVID-19. These included ensuring business continuity by splitting the transplant team into different locations, adopting video and tele-consults to minimise potential patient exposure to COVID-19, streamlining work processes using electronic forms, ensuring safe paths for patients who needed to come to hospital, ring-fencing and testing new inpatients at risk for COVID-19, enhancing precautionary measures for transplant surgery, ensuring a stable supply chain of immunosuppression, and sustaining patient and staff education programmes via video conferencing. Conclusions: Though the COVID-19 pandemic has reduced access to kidney transplantation, opportunities arose to adopt telemedicine into mainstream transplant practice as well as use electronic platforms to streamline work processes. Screening protocols were established to ensure that transplantation could be performed safely, while webinars reached out to empower patients to take precautions against COVID-19. Keywords: COVID-19, Nephrology, Public Health, Renal Transplant, Transplantation, Urology

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High-immunological risk living donor renal transplant during the COVID-19 outbreak: Uncertainties and ethical dilemmas

Cited by 12 publications

References 5 publications

Urology during COVID-19 Pandemic Crisis: A Systematic Review

Urology during COVID-19 Pandemic Crisis: A Systematic Review

Transplantation in the era of the Covid‐19 pandemic: How should transplant patients and programs be handled?

Managing a Renal Transplant Programme During the COVID-19 Pandemic: Practical Experience from a Singapore Transplant Centre

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