Bioethical perspective of convalescent plasma therapy for COVID-19: A systematic review

Abstract

Convalescent plasma therapy (CP) has long been used to prevent and treat various infectious diseases before COVID-19 such as SARS, MERS, and H1N1. Because the viral and clinical characteristics of COVID-19 share the similarities between SARS and MERS, CP treatment could be a promising treatment option to save COVID-19. With only low quality medical evidence, but massive media support and a very significant public demand for the use of convalescent plasma for COVID-19, we are now faced with an ethical dilemma. Therefore, this paper uses a structured analysis that focuses on the preferred reporting items for a systematic review of ethical issues regarding the use of Convalescent Plasma Therapy for COVID-19. The use of convalescent plasma must meet the ethical principles of autonomy; such as voluntary, informed consent, and confidentiality. Consideration of the risk-benefit ratio for potential donor recipients also needs to be considered in order to meet the beneficence and non-maleficence principles. The principle of justice also needs to be applied both to donors, donor recipients and health workers, such as determining the priority of donor recipients, due to the increasing demand for convalescent plasma amid the limited circumstances of patients who have recovered from Covid-19 who voluntarily donate.

A medical ethics review of elective orthopaedic surgery management during the pandemic COVID-19 Era

“…Furthermore, elective major orthopaedic surgeries, such as hip replacement surgery or proximal femur surgery, require an adequate blood supply [ 30 ]. On the other hand, the need for blood during the pandemic has significantly increased, especially the demand for convalescent plasma [ 31 ].…”

Safety and Efficacy of Convalescent Plasma in COVID-19: An Overview of Systematic Reviews

“…The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram is reported in Figure 1 . After the full texts were scrutinized against the inclusion and exclusion criteria, 29 SRs were included in the umbrella review [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ] and 23 SRs were excluded [ 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , …”

“…After the full texts were scrutinized against the inclusion and exclusion criteria, 29 SRs were included in the umbrella review [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ] and 23 SRs were excluded [ 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ]. Reasons for exclusion were: SRs not covering or with no informative data on CP therapy...…”

Effectiveness of convalescent plasma therapy for COVID-19 patients infected with variants of concerns

“…5,18,43 It proved to decrease the viral load, cytokine response, and mortality rate. 44,45,46 CPT involves collection of plasma from the recovered patients via apheresis and transfused to symptomatic patients, assuming the donor has developed antibodies against the causal agent of the disease. 47,48 During apheresis, neutralizing antibodies (NAbs) and other proteins such as clotting factors, anti-inflammatory cytokines, defensins, pentraxins, natural antibodies, and other undefined proteins are collected from donors.…”