Liver transplantation from active COVID-19 donors: Is it ethically justifiable?
Alessandra Agnese Grossi
Center for Clinical Ethics, Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
Department of Human Sciences, Innovation and Territory, University of Insubria, Varese, Italy
Search for more papers by this authorFederico Nicoli
Center for Clinical Ethics, Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
Clinical Ethics Service, Domus Salutis Clinic, Teresa Camplani Foundation, Brescia, Italy
Search for more papers by this authorMassimo Cardillo
Italian National Transplantation Center (CNT), Italian National Institute of Health, Rome, Italy
Search for more papers by this authorSalvatore Gruttadauria
Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT, UPMC (University of Pittsburgh Medical Center), Palermo, Italy
Department of Surgery and Medical and Surgical Specialties, University of Catania, Catania, Italy
Search for more papers by this authorGiuseppe Tisone
Department of Surgical Sciences, University of Rome - Tor Vergata, Rome, Italy
Search for more papers by this authorGiuseppe Maria Ettorre
Department of General and HBP Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, Rome, Italy
Search for more papers by this authorLuciano De Carlis
General Surgery and Abdominal Transplantation Unit, University of Milano-Bicocca and Niguarda-Cà Granda Hospital, Milan, Italy
Search for more papers by this authorRenato Romagnoli
General Surgery 2U and Liver Transplantation Center, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
Search for more papers by this authorCarlo Petrini
Bioethics Unit, Italian National Institute of Health (ISS), Rome, Italy
Search for more papers by this authorCorresponding Author
Paolo Antonio Grossi
Italian National Transplantation Center (CNT), Italian National Institute of Health, Rome, Italy
Department of Medicine and Surgery, Infectious and Tropical Diseases Unit, University of Insubria, ASST Sette Laghi, Varese, Italy
Correspondence
Paolo Antonio Grossi, Department of Medicine and Surgery, Infectious and Tropical Diseases Unit, University of Insubria, ASST Sette Laghi, Varese, Italy.
Email: [email protected]
Search for more papers by this authorMario Picozzi
Center for Clinical Ethics, Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
Search for more papers by this authorAlessandra Agnese Grossi
Center for Clinical Ethics, Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
Department of Human Sciences, Innovation and Territory, University of Insubria, Varese, Italy
Search for more papers by this authorFederico Nicoli
Center for Clinical Ethics, Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
Clinical Ethics Service, Domus Salutis Clinic, Teresa Camplani Foundation, Brescia, Italy
Search for more papers by this authorMassimo Cardillo
Italian National Transplantation Center (CNT), Italian National Institute of Health, Rome, Italy
Search for more papers by this authorSalvatore Gruttadauria
Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT, UPMC (University of Pittsburgh Medical Center), Palermo, Italy
Department of Surgery and Medical and Surgical Specialties, University of Catania, Catania, Italy
Search for more papers by this authorGiuseppe Tisone
Department of Surgical Sciences, University of Rome - Tor Vergata, Rome, Italy
Search for more papers by this authorGiuseppe Maria Ettorre
Department of General and HBP Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, Rome, Italy
Search for more papers by this authorLuciano De Carlis
General Surgery and Abdominal Transplantation Unit, University of Milano-Bicocca and Niguarda-Cà Granda Hospital, Milan, Italy
Search for more papers by this authorRenato Romagnoli
General Surgery 2U and Liver Transplantation Center, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
Search for more papers by this authorCarlo Petrini
Bioethics Unit, Italian National Institute of Health (ISS), Rome, Italy
Search for more papers by this authorCorresponding Author
Paolo Antonio Grossi
Italian National Transplantation Center (CNT), Italian National Institute of Health, Rome, Italy
Department of Medicine and Surgery, Infectious and Tropical Diseases Unit, University of Insubria, ASST Sette Laghi, Varese, Italy
Correspondence
Paolo Antonio Grossi, Department of Medicine and Surgery, Infectious and Tropical Diseases Unit, University of Insubria, ASST Sette Laghi, Varese, Italy.
Email: [email protected]
Search for more papers by this authorMario Picozzi
Center for Clinical Ethics, Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
Search for more papers by this authorAbstract
The debate on the opportunity to use organs from donors testing positive for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in recipients with naïve resolved or active COVID-19 is ongoing. We aim to present the ethical analyses underlying the decision to perform liver transplantation (LT) in selected patients with resolved or active COVID-19 in Italy. We used Jonsen, Siegler, and Winslade's Four-Boxes casuistic method, addressing the four topics considered as constitutive of the essential structure of single clinical cases for their ethical analysis (medical indications, patient preferences, quality of life, and contextual features) to enable decision-making on a case-by-case basis. Based on these topics, we elucidate the meaning and balance among the principles of biomedical ethics. Clinical ethics judgment based on the relation between the risk of acquiring SARS-CoV-2 along with its potentially negative effects and the expected benefits of transplant lead to consider LT as clinically appropriate. Shared decision-making allows the integration of clinical options with the patient's subjective preferences and considerations, enabling a valid informed consent specifically tailored to the patients’ individual circumstances. The inclusion of carefully selected SARS-CoV-2 positive donors represents an opportunity to offer lifesaving LT to patients who might otherwise have limited opportunities to receive one. COVID-19 positive donor livers are fairly allocated among equals, and respect for fundamental rights of the individual and the broader community in a context of healthcare rationing is guaranteed.The ethical analysis of the decision to perform LT in selected patients shows that the decision is ethically justifiable.
CONFLICT OF INTEREST
The authors have no conflict of interest to disclose as described by Transplant Infectious Disease.
Supporting Information
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| tid13846-sup-0002-GraphicalAbstract.tif1.6 MB | Supplementary Appendix |
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