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Kidney transplantation during mass disasters-from COVID-19 to other catastrophes : a Consensus Statement by the DESCARTES Working Group and Ethics Committee of the ERA

Mehmet Sukru Sever, Raymond Vanholder (UGent) , Gabriel Oniscu, Daniel Abramowicz, Wim Van Biesen (UGent) , Umberto Maggiore, Bruno Watschinger, Christophe Mariat, Jadranka Buturovic-Ponikvar, Marta Crespo, et al.
(2023) NEPHROLOGY DIALYSIS TRANSPLANTATION. 38(2). p.300-308
Author
Organization
Abstract
Mass disasters are characterized by a disparity between healthcare demand and supply, which hampers complex therapies like kidney transplantation. Considering the scarcity of publications on previous disasters, we reviewed transplantation practice during the recent coronavirus disease 2019 (COVID-19) pandemic, and dwelled upon this experience to guide transplantation strategies in the future pandemic and non-pandemic catastrophes. We strongly suggest continuing transplantation programs during mass disasters, if medical and logistic operational circumstances are appropriate. Postponing transplantations from living donors and referral of urgent cases to safe regions or hospitals are justified. Specific preventative measures in anticipated disasters (such as vaccination programs during pandemics or evacuation in case of hurricanes or wars) may be useful to minimize risks. Immunosuppressive therapies should consider stratifying risk status and avoiding heavy immune suppression in patients with a low probability of therapeutic success. Discharging patients at the earliest convenience is justified during pandemics, whereas delaying discharge is reasonable in other disasters, if infrastructural damage results in unhygienic living environments for the patients. In the outpatient setting, telemedicine is a useful approach to reduce the patient load to hospitals, to minimize the risk of nosocomial transmission in pandemics and the need for transport in destructive disasters. If it comes down to saving as many lives as possible, some ethical principles may vary in function of disaster circumstances, but elementary ethical rules are non-negotiable. Patient education is essential to minimize disaster-related complications and to allow for an efficient use of healthcare resources.
Keywords
COVID-19 pandemic, disasters, earthquakes, earthquakes, kidney transplantation, vaccination

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MLA
Sever, Mehmet Sukru, et al. “Kidney Transplantation during Mass Disasters-from COVID-19 to Other Catastrophes : A Consensus Statement by the DESCARTES Working Group and Ethics Committee of the ERA.” NEPHROLOGY DIALYSIS TRANSPLANTATION, vol. 38, no. 2, 2023, pp. 300–08, doi:10.1093/ndt/gfac251.
APA
Sever, M. S., Vanholder, R., Oniscu, G., Abramowicz, D., Van Biesen, W., Maggiore, U., … Hilbrands, L. (2023). Kidney transplantation during mass disasters-from COVID-19 to other catastrophes : a Consensus Statement by the DESCARTES Working Group and Ethics Committee of the ERA. NEPHROLOGY DIALYSIS TRANSPLANTATION, 38(2), 300–308. https://doi.org/10.1093/ndt/gfac251
Chicago author-date
Sever, Mehmet Sukru, Raymond Vanholder, Gabriel Oniscu, Daniel Abramowicz, Wim Van Biesen, Umberto Maggiore, Bruno Watschinger, et al. 2023. “Kidney Transplantation during Mass Disasters-from COVID-19 to Other Catastrophes : A Consensus Statement by the DESCARTES Working Group and Ethics Committee of the ERA.” NEPHROLOGY DIALYSIS TRANSPLANTATION 38 (2): 300–308. https://doi.org/10.1093/ndt/gfac251.
Chicago author-date (all authors)
Sever, Mehmet Sukru, Raymond Vanholder, Gabriel Oniscu, Daniel Abramowicz, Wim Van Biesen, Umberto Maggiore, Bruno Watschinger, Christophe Mariat, Jadranka Buturovic-Ponikvar, Marta Crespo, Geir Mjoen, Peter Heering, Licia Peruzzi, Ilaria Gandolfini, Rachel Hellemans, and Luuk Hilbrands. 2023. “Kidney Transplantation during Mass Disasters-from COVID-19 to Other Catastrophes : A Consensus Statement by the DESCARTES Working Group and Ethics Committee of the ERA.” NEPHROLOGY DIALYSIS TRANSPLANTATION 38 (2): 300–308. doi:10.1093/ndt/gfac251.
Vancouver
1.
Sever MS, Vanholder R, Oniscu G, Abramowicz D, Van Biesen W, Maggiore U, et al. Kidney transplantation during mass disasters-from COVID-19 to other catastrophes : a Consensus Statement by the DESCARTES Working Group and Ethics Committee of the ERA. NEPHROLOGY DIALYSIS TRANSPLANTATION. 2023;38(2):300–8.
IEEE
[1]
M. S. Sever et al., “Kidney transplantation during mass disasters-from COVID-19 to other catastrophes : a Consensus Statement by the DESCARTES Working Group and Ethics Committee of the ERA,” NEPHROLOGY DIALYSIS TRANSPLANTATION, vol. 38, no. 2, pp. 300–308, 2023.
@article{8770639,
  abstract     = {{Mass disasters are characterized by a disparity between healthcare demand and supply, which hampers complex therapies like kidney transplantation. Considering the scarcity of publications on previous disasters, we reviewed transplantation practice during the recent coronavirus disease 2019 (COVID-19) pandemic, and dwelled upon this experience to guide transplantation strategies in the future pandemic and non-pandemic catastrophes. We strongly suggest continuing transplantation programs during mass disasters, if medical and logistic operational circumstances are appropriate. Postponing transplantations from living donors and referral of urgent cases to safe regions or hospitals are justified. Specific preventative measures in anticipated disasters (such as vaccination programs during pandemics or evacuation in case of hurricanes or wars) may be useful to minimize risks. Immunosuppressive therapies should consider stratifying risk status and avoiding heavy immune suppression in patients with a low probability of therapeutic success. Discharging patients at the earliest convenience is justified during pandemics, whereas delaying discharge is reasonable in other disasters, if infrastructural damage results in unhygienic living environments for the patients. In the outpatient setting, telemedicine is a useful approach to reduce the patient load to hospitals, to minimize the risk of nosocomial transmission in pandemics and the need for transport in destructive disasters. If it comes down to saving as many lives as possible, some ethical principles may vary in function of disaster circumstances, but elementary ethical rules are non-negotiable. Patient education is essential to minimize disaster-related complications and to allow for an efficient use of healthcare resources.}},
  author       = {{Sever, Mehmet Sukru and Vanholder, Raymond and Oniscu, Gabriel and Abramowicz, Daniel and Van Biesen, Wim and Maggiore, Umberto and Watschinger, Bruno and Mariat, Christophe and Buturovic-Ponikvar, Jadranka and Crespo, Marta and Mjoen, Geir and Heering, Peter and Peruzzi, Licia and Gandolfini, Ilaria and Hellemans, Rachel and Hilbrands, Luuk}},
  issn         = {{0931-0509}},
  journal      = {{NEPHROLOGY DIALYSIS TRANSPLANTATION}},
  keywords     = {{COVID-19 pandemic,disasters,earthquakes,earthquakes,kidney transplantation,vaccination}},
  language     = {{eng}},
  number       = {{2}},
  pages        = {{300--308}},
  title        = {{Kidney transplantation during mass disasters-from COVID-19 to other catastrophes : a Consensus Statement by the DESCARTES Working Group and Ethics Committee of the ERA}},
  url          = {{http://doi.org/10.1093/ndt/gfac251}},
  volume       = {{38}},
  year         = {{2023}},
}
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