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Agnese GA, Federico N, Massimo C, Salvatore G, Giuseppe T, Maria EG, Luciano DC, Renato R, Carlo P, Antonio GP, Mario P. Liver transplantation from active COVID-19 donors: is it ethically justifiable? Transpl Infect Dis 2022; 24:e13846. [PMID: 35579913 PMCID: PMC9348408 DOI: 10.1111/tid.13846] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/11/2022] [Accepted: 04/16/2022] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Grossi Alessandra Agnese
- 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
| | - Nicoli Federico
- 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
| | - Cardillo Massimo
- Italian National Transplantation Center (CNT), Italian National Institute of Health, Rome, Italy
| | - Gruttadauria Salvatore
- 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
| | - Tisone Giuseppe
- Department of Surgical Sciences, University of Rome - Tor Vergata, Rome, Italy
| | - Ettorre Giuseppe Maria
- Department of General and HBP Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, Rome, Italy
| | - De Carlis Luciano
- General Surgery and Abdominal Transplantation Unit, University of Milano-Bicocca and Niguarda-Cà Granda Hospital, Milan, Italy
| | - Romagnoli Renato
- General Surgery 2U and Liver Transplantation Center, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Petrini Carlo
- Bioethics Unit, Italian National Institute of Health (ISS), Rome, Italy
| | - Grossi Paolo Antonio
- Italian National Transplantation Center (CNT), Italian National Institute of Health, Rome, Italy.,Department of Medicine and Surgery, Infectious Disease Unit, University of Insubria, Varese, Italy
| | - Picozzi Mario
- Center for Clinical Ethics, Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
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