{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T23:24:02Z","timestamp":1770420242129,"version":"3.49.0"},"reference-count":29,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2022,1,4]],"date-time":"2022-01-04T00:00:00Z","timestamp":1641254400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Med Ethics"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:p>The transplant community has faced unprecedented challenges balancing risks of performing living donor transplants during the COVID-19 pandemic with harms of temporarily suspending these procedures. Decisions regarding postponement of living donation stem from its designation as an elective procedure, this despite that the Centers for Medicare and Medicaid Services categorise transplant procedures as tier 3b (high medical urgency\u2014do not postpone). In times of severe resource constraints, health systems may be operating under crisis or contingency standards of care. In this manuscript, the United Network for Organ Sharing Ethics Workgroup explores prioritisation of living donation where health systems operate under contingency standards of care and provide a framework with recommendations to the transplant community on how to approach living donation in these circumstances.<\/jats:p><jats:p>To guide the transplant community in future decisions, this analysis suggests that: (1) living donor transplants represent an important option for individuals with end-stage liver and kidney disease and should not be suspended uniformly under contingency standards, (2) exposure risk to SARS-CoV-2 should be balanced with other risks, such as exposure risks at dialysis centres. Because many of these risks are not quantifiable, donors and recipients should be included in discussions on what constitutes acceptable risk, (3) transplant hospitals should strive to maintain a critical transplant workforce and avoid diverting expertise, which could negatively impact patient preparedness for transplant, (4) transplant hospitals should consider implementing protocols to ensure early detection of SARS-CoV-2 infections and discuss these measures with donors and recipients in a process of shared decision-making.<\/jats:p>","DOI":"10.1136\/medethics-2021-107574","type":"journal-article","created":{"date-parts":[[2022,1,4]],"date-time":"2022-01-04T18:25:47Z","timestamp":1641320747000},"page":"389-392","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Ethical analysis examining the prioritisation of living donor transplantation in times of healthcare rationing"],"prefix":"10.1136","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0835-7907","authenticated-orcid":false,"given":"Sanjay","family":"Kulkarni","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Flescher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahwish","family":"Ahmad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George","family":"Bayliss","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Bearl","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lynsey","family":"Biondi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Earnest","family":"Davis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roshan","family":"George","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisa","family":"Gordon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tania","family":"Lyons","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron","family":"Wightman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4310-8260","authenticated-orcid":false,"given":"Keren","family":"Ladin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,1,4]]},"reference":[{"issue":"11","key":"2023061504000963000_49.6.389.1","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2020.27315","article-title":"Us clinicians' experiences and perspectives on resource limitation and patient care during the COVID-19 pandemic","volume":"3","author":"Butler","year":"2020","journal-title":"JAMA Netw Open"},{"issue":"10","key":"2023061504000963000_49.6.389.2","doi-asserted-by":"crossref","first-page":"1262","DOI":"10.1002\/bjs.11750","article-title":"Personal protective equipment for surgeons during COVID-19 pandemic: systematic review of availability, usage and rationing","volume":"107","author":"Jessop","year":"2020","journal-title":"Br J Surg"},{"key":"2023061504000963000_49.6.389.3","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-020-06092-5"},{"issue":"9","key":"2023061504000963000_49.6.389.4","doi-asserted-by":"crossref","first-page":"2332","DOI":"10.1111\/ajt.15914","article-title":"Coronavirus disease 2019: utilizing an ethical framework for rationing absolutely scarce health\u2010care resources in transplant allocation decisions","volume":"20","author":"Wall","year":"2020","journal-title":"Am J Transplant"},{"key":"2023061504000963000_49.6.389.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60137-9"},{"key":"2023061504000963000_49.6.389.6","doi-asserted-by":"publisher","DOI":"10.1111\/bioe.12771"},{"key":"2023061504000963000_49.6.389.7","unstructured":"Institute of Medicine (US) Forum on Medical and Public Health Preparedness for Catastrophic Events . 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