An international multicentre study of protocols for liver transplantation during a pandemic: A case for quadripartite equipoise.

Chew, Claire Alexandra, Iyer, Shridhar Ganpathi, Chieh Kow, Alfred Wei, Madhavan, Krishnakumar, Teng Wong, Andrea Sze, Halazun, Karim J, Battula, Narendra, Scalera, Irene, Angelico, Roberta, Farid, Sharid, Buchholz, Bettina M, Rotellar, Fernando, Chi-Yan Chan, Albert, Kim, Jong Man, Wang, Chih-Chi, Pitchaimuthu, Maheswaran, Reddy, Mettu Srinivas, Soin, Arvinder Singh, Derosas, Carlos, Imventarza, Oscar, Isaac, John, Muiesan, Paolo, Mirza, Darius F and Bonney, Glenn Kunnath (2020) An international multicentre study of protocols for liver transplantation during a pandemic: A case for quadripartite equipoise. Journal of hepatology. ISSN 1600-0641. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs

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Abstract

BACKGROUND

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 multi-center 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 twelve countries across four 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 seven 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 to allow greater global solidarity and transparency in these austere times.

Item Type:	Article
Additional Information:	This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs
Subjects:	WA Patients. Primary care. Medical profession. Forensic medicine WC Communicabable diseases WI Digestive system. Gastroenterology
Related URLs:	https://pubmed.ncbi.nlm.nih.gov/32454041...
Depositing User:	Mrs Yolande Brookes
Date Deposited:	05 Jun 2020 11:25
Last Modified:	05 Jun 2020 11:25
URI:	http://www.repository.uhblibrary.co.uk/id/eprint/3144

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