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Organ donation in the time of COVID-19: the Israeli experience one year into the pandemic—ethical and policy implications

PURPOSE: To present the response of the Israel National Transplantation Center (NTC) to the evolving challenge of COVID-19, the impact on deceased organ donation and living organ kidney donation during 2020, and resultant policy and ethical implications. METHODS: Data collected included (i) for dece...

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Autores principales: Katvan, Eyal, Cohen, Jonathan, Ashkenazi, Tamar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8802285/
https://www.ncbi.nlm.nih.gov/pubmed/35101144
http://dx.doi.org/10.1186/s13584-022-00519-8
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author Katvan, Eyal
Cohen, Jonathan
Ashkenazi, Tamar
author_facet Katvan, Eyal
Cohen, Jonathan
Ashkenazi, Tamar
author_sort Katvan, Eyal
collection PubMed
description PURPOSE: To present the response of the Israel National Transplantation Center (NTC) to the evolving challenge of COVID-19, the impact on deceased organ donation and living organ kidney donation during 2020, and resultant policy and ethical implications. METHODS: Data collected included (i) for deceased donors, the total number of potential organ donors, if hospitalized in ICU or general ward, cause of death, number of family authorizations and refusals, number of actual donors, number of organs transplanted/donor and total number of transplants performed; (ii) for living-kidney-donors (related or altruistic), the number of procedures performed; and (iii) the number of patients registered on the national organ waiting-list. RESULTS: Following the first case (February 2020), deceased organ donation continued uninterrupted. The total number of potential donors was similar to 2019 (181 vs. 189). However, the number of families approached for donation decreased significantly (P = 0.02). This may be attributed to COVID-19-imposed limitations including fewer brain death determinations due to limited possibilities for face-to-face donor coordinator-donor family interactions providing emotional support and visual explanations of the medical situation. Fewer donors were admitted to ICU (P = 0.1) and the number of organs retrieved/donor decreased (3.8/donor to 3.4/donor). The overall result was a decrease of 24.2% in the number of transplant procedures (306 vs. 232). Living kidney donation, initially halted, resumed in May and the total number of procedures increased compared to 2019 due to a significant increase in altruistic donations (P < 0.0001), while the number of related-living donations decreased. CONCLUSION: This study of organ donation during a crisis has informed the introduction of policy changes in the NTC including the necessity to mobilize rapidly a “war room”, the use of innovative virtual tools for contact-less communication, and the importance of cooperation with hospital authorities in allocating scarce health-care resources. Finally, the pandemic highlighted and intensified ethical considerations, such as under what circumstances living kidney donation be continued in the face of uncertainty, and what information to provide to altruistic donors regarding a prospective recipient, in particular whether all options for related living donation have been exhausted. These should be addressed now.
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spelling pubmed-88022852022-01-31 Organ donation in the time of COVID-19: the Israeli experience one year into the pandemic—ethical and policy implications Katvan, Eyal Cohen, Jonathan Ashkenazi, Tamar Isr J Health Policy Res Original Research Article PURPOSE: To present the response of the Israel National Transplantation Center (NTC) to the evolving challenge of COVID-19, the impact on deceased organ donation and living organ kidney donation during 2020, and resultant policy and ethical implications. METHODS: Data collected included (i) for deceased donors, the total number of potential organ donors, if hospitalized in ICU or general ward, cause of death, number of family authorizations and refusals, number of actual donors, number of organs transplanted/donor and total number of transplants performed; (ii) for living-kidney-donors (related or altruistic), the number of procedures performed; and (iii) the number of patients registered on the national organ waiting-list. RESULTS: Following the first case (February 2020), deceased organ donation continued uninterrupted. The total number of potential donors was similar to 2019 (181 vs. 189). However, the number of families approached for donation decreased significantly (P = 0.02). This may be attributed to COVID-19-imposed limitations including fewer brain death determinations due to limited possibilities for face-to-face donor coordinator-donor family interactions providing emotional support and visual explanations of the medical situation. Fewer donors were admitted to ICU (P = 0.1) and the number of organs retrieved/donor decreased (3.8/donor to 3.4/donor). The overall result was a decrease of 24.2% in the number of transplant procedures (306 vs. 232). Living kidney donation, initially halted, resumed in May and the total number of procedures increased compared to 2019 due to a significant increase in altruistic donations (P < 0.0001), while the number of related-living donations decreased. CONCLUSION: This study of organ donation during a crisis has informed the introduction of policy changes in the NTC including the necessity to mobilize rapidly a “war room”, the use of innovative virtual tools for contact-less communication, and the importance of cooperation with hospital authorities in allocating scarce health-care resources. Finally, the pandemic highlighted and intensified ethical considerations, such as under what circumstances living kidney donation be continued in the face of uncertainty, and what information to provide to altruistic donors regarding a prospective recipient, in particular whether all options for related living donation have been exhausted. These should be addressed now. BioMed Central 2022-01-31 /pmc/articles/PMC8802285/ /pubmed/35101144 http://dx.doi.org/10.1186/s13584-022-00519-8 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Original Research Article
Katvan, Eyal
Cohen, Jonathan
Ashkenazi, Tamar
Organ donation in the time of COVID-19: the Israeli experience one year into the pandemic—ethical and policy implications
title Organ donation in the time of COVID-19: the Israeli experience one year into the pandemic—ethical and policy implications
title_full Organ donation in the time of COVID-19: the Israeli experience one year into the pandemic—ethical and policy implications
title_fullStr Organ donation in the time of COVID-19: the Israeli experience one year into the pandemic—ethical and policy implications
title_full_unstemmed Organ donation in the time of COVID-19: the Israeli experience one year into the pandemic—ethical and policy implications
title_short Organ donation in the time of COVID-19: the Israeli experience one year into the pandemic—ethical and policy implications
title_sort organ donation in the time of covid-19: the israeli experience one year into the pandemic—ethical and policy implications
topic Original Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8802285/
https://www.ncbi.nlm.nih.gov/pubmed/35101144
http://dx.doi.org/10.1186/s13584-022-00519-8
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