key: cord-1047841-y34k7zsq
authors: Ho, Quan Yao; Chung, Shimin J.; Gan, Valerie H. L.; Ng, Lay Guat; Tan, Ban Hock; Kee, Terence Y. S.
title: High‐immunological risk living donor renal transplant during the COVID‐19 outbreak: Uncertainties and ethical dilemmas
date: 2020-05-08
journal: Am J Transplant
DOI: 10.1111/ajt.15949
sha: 8dd6bee9fffe961b55ac72562fc534b9979d84ad
doc_id: 1047841
cord_uid: y34k7zsq

We describe the challenges of performing a high-immunological risk living donor renal transplant during the COVID-19 outbreak. A 42-year-old lady with end-stage renal disease from lupus nephritis had failed peritoneal dialysis due to pleuro-peritoneal leak, failed vascular access creation due to early thrombosis and had recurrent dialysis catheter malfunction. The transplant from her husband was ABO-incompatible and had positive B cell flow crossmatch with multiple donor-specific antibodies. Neither alternative donors nor paired exchange candidates were available. Priority access to deceased donors is limited and unpredictable.

• Risk of healthcareassociated, communityacquired or donor-derived infection • Potential adverse psychosocial effects due to heightened infection control measures for recipients (eg, social distancing, prolonged isolation)

• Risk of healthcare-associated (eg, dialysis center) or community-acquired infection • Adverse medical and psychosocial effects from prolonged dialysis (eg, recurrent dialysis access-related complications) • Loss of access to transplantation may be prolonged, with risk of exclusion from transplantation due to disease progression or death • Poorer posttransplant outcomes with prolonged duration on dialysis Performing transplantation during a viral pandemic will continue to be challenging. Precautions to mitigate COVID-19 transmission must be undertaken, and adequate healthcare resources must be secured before proceeding. Patient engagement is important, and we provide a possible framework for discussion (Table 1) .

clinical decision-making, clinical research/practice, ethics, ethics and public policy, infection and infectious agents -viral, infectious disease, kidney transplantation/nephrology

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The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.Quan Yao Ho 1, 4 Shimin J. Chung 2, 4 Valerie H. L. Gan 3, 4 Lay Guat Ng 3, 4 Ban Hock Tan 2,4 Terence Y. S. Kee 1,4