Liver Transplantation in the Time of COVID19: Barriers and Ethical Considerations for Management and Next Steps

Abstract

Transplant programs must re‐evaluate the ethicality, feasibility, and safety of performing liver transplants during this pandemic. Herein, we discuss the clinical and ethical challenges posed by performing liver transplants and offer guidance for managing patients with end‐stage liver disease during the COVID19 pandemic.

Surgical treatment of hepatocellular carcinoma in the era of COVID-19 pandemic: A comprehensive review of current recommendations

“…The COVID-19 outbreak has affected liver transplantation programmes worldwide, especially in communities where the incidence of COVID-19 is high and resources required for transplant activities, such as ICU beds, ventilators, and blood products, are limited[ 3 ]. In the United States, the Centers for Medicare and Medicaid Services consider transplant surgery Tier 3b category (“do not postpone”), and despite an initial decrease in liver transplantations at the beginning of the COVID-19 pandemic, liver transplant volumes have returned to 2019 levels[ 20 ].…”

“…Acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for coronavirus disease 2019 (COVID-19), which has been spreading worldwide since the end of 2019, causing a global health system crisis[ 1 - 3 ]. Along with serious effects on the patients affected by the new coronavirus infection, the pandemic has also led to deleterious repercussions on patients affected by other diseases.…”

Liver transplantation during global COVID-19 pandemic

“…The rapid outbreak of COVID-19 led to a scarcity of resources and disrupted normal operations in many hospitals and transplant centers worldwide[ 21 ]. During the six-month hiatus in performing LTs at a transplant center in Hong Kong, lower adherence to follow-up and two deaths were reported[ 22 ].…”

Keeping the lights on: Telehealth, testing, and 6-month outcomes for orthotopic liver transplantation during the COVID-19 pandemic

“…( 13 ) Moreover, ethical concerns regarding continuing our mission to care for these patients during the COVID-19 pandemic, while also being good stewards of available resources, have been raised in the transplant community. ( 14 , 15 ) Further complicating the landscape, many experts have predicted a new surge in COVID-19 cases in the coming months. ( 5 ) Despite the expedient vaccine development efforts of “Operation Warp Speed,” currently finishing accrual with multiple candidates in phase III trials, mass vaccination in the United States is predicted to take until at least mid-late 2021.…”