The problem considered in this work stems from a non-profit organization in charge of doorto-door passenger transportation for medical appointments. Patients are picked up at home by a driver and are then dropped at their appointment location. They may also be driven back home at the end of their appointment. Some patients have specific requirements, e.g., they may require an accompanying person or a wheelchair. Planning such activities gives rise to a so-called dial-a-ride problem. In the present work, it is assumed that the requests assigned to the drivers have been selected, and the transportation plan has been established for the next day. However, in practice, appointment durations may vary due to unforeseen circumstances, and some transportation requests may be modified, delayed or canceled during the day. The aim of this work is to propose a reactive algorithm which can adapt the initial plan in order to manage the disruptions and to take care of as many patients as possible in real-time. The plan should be modified quickly when a perturbation is observed, without resorting to major changes which may confuse the drivers and the patients. Several recourse procedures are defined for this purpose. They allow the dispatcher to temporarily delete a request, to insert a previously deleted request, or to permanently cancel a request. Simulation techniques are used to test the approach on randomly generated scenarios. Several key performance indicators are introduced in order to measure the impact of the disruptions and the quality of the solutions.