To Procure or Not to Procure: Hospitals Face Significant Ethical Dilemmas Regarding Organ Donation During the COVID-19 Pandemic

The COVID-19 pandemic and organ donation and transplantation: ethical issues

Background

The COVID-19 pandemic has had a significant impact on the health system worldwide. The organ and tissue donation and transplantation (OTDT) system is no exception and has had to face ethical challenges related to the pandemic, such as risks of infection and resource allocation. In this setting, many Canadian transplant programs halted their activities during the first wave of the pandemic.

Method

To inform future ethical guidelines related to the COVID-19 pandemic or other public health emergencies of international concern, we conducted a literature review to summarize the ethical issues.

Results

This literature review identified three categories of ethical challenges. The first one describes the general ethical issues and challenges reported by OTDT organizations and transplantation programs, such as risks of COVID-19 transmission and infection to transplant recipients and healthcare professionals during the transplant process, risk of patient waitlist mortality or further resource strain where transplant procedures have been delayed or halted, and resource allocation. The second category describes ethical challenges related to informed consent in the context of uncertainty and virtual consent. Finally, the third category describes ethical issues related to organ allocation, such as social considerations in selecting transplant candidates.

Conclusion

This literature review highlights the salient ethical issues related to OTDT during the current COVID-19 pandemic. As medical and scientific knowledge about COVID-19 increases, the uncertainties related to this disease will decrease and the associated ethical issues will continue to evolve.

COVID-19 and the Response of Transplant Centers: the Global Response with an Emphasis on the Kidney Recipient

Purpose of the Review

In response to the COVID-19 pandemic, vulnerable populations, such as transplant patients, were at greater risk than the regular population. In order to protect these populations, transplant centers enacted new guidelines. We approach this review by looking at how different transplant regions responded to COVID-19 and analyze the unifying themes that have proven invaluable in the subsequent waves.

Recent Findings

We noticed that most elective surgeries including living donor transplant operations were suspended in most countries. The response to deceased donor transplants varied between countries: in some deceased donor transplants continued with modified donor and recipient criteria, while in other countries this surgery was suspended. There was a general trend of decreasing or holding antimetabolites, treating the virus with hydroxychloroquine and/or azithromycin, and converting outpatient clinics to virtual clinics.

Summary

We learned how to carefully select donors and recipients, tailor immunosuppressant regiments, and implement telemedicine. The kidney recipient population can be effectively managed in times of crisis with appropriate accommodations and measures. This review can be a model for the transplant community for future pandemics.

Transmission and evaporation of cough droplets in an elevator: Numerical simulations of some possible scenarios

As the world learns to live with COVID-19 and activities/business open up, the use of elevators becomes frequent. A pertinent question is what happens if someone accidentally coughs inside the elevator. In this work, a three dimensional Euler-Lagrangian model is used to understand the transmission and evaporation of micrometer-sized droplets in such cases. The effect of turbulence created by the air puff associated with coughing has been considered. Different possible scenarios varying in the presence of air ventilation within the elevator, number of persons coughing, direction of ejection of cough droplets, and ambient relative humidity and temperature have been postulated and simulated. The results obtained show that in the presence of proper ventilation within the elevator, most of the ejected cough droplets fall to the ground before impacting other persons traveling in the same elevator. However, in the absence of proper ventilation, the turbulence created during coughing transmits the particles all across the elevator enclosure.