Decreased access to pediatric liver transplantation during the COVID‐19 pandemic

Kemme, Sarah; Yoeli, Dor; Sundaram, Shikha S.; Adams, Megan; Feldman, Amy G.

doi:10.1111/petr.14162

Cited by 8 publications

(11 citation statements)

References 33 publications

(75 reference statements)

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“…Perturbations in global health and economy have only further widened these racial and ethnic health disparities. [ 42 ] Racial health inequities should not be attributed to “unmeasured genetic or biological factors” or patient mistrust. [ 43 ] Stigmatizing, biased, and racist language must be removed from the health care setting.…”

Section: Addressing Disparities In Pediatric Liver Transplantationmentioning

confidence: 99%

A review of racial, socioeconomic, and geographic disparities in pediatric liver transplantation

Ebel

Lai

Bucuvalas

et al. 2022

Liver Transplantation

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Equity is a core principle in both pediatrics and solid organ transplantation. Health inequities, specifically across race, socioeconomic position, or geography, reflect a moral failure. Ethical principles of prudential life span, maximin principle, and fair innings argue for allocation priority to children related to the number of life years gained, equal access to transplant, and equal opportunity for ideal posttransplant outcomes. Iterative policy changes have aimed to narrow these disparities to achieve pediatric transplant equity. These policy changes have focused on modifying pediatric priority for organ allocation to eliminate mortality on the pediatric transplant waiting list. Yet disparities remain in pediatric liver transplantation at all time points: from access to referral for transplantation, likelihood of living donor transplantation, use of exception narratives, waitlist mortality, and inequitable posttransplant outcomes. Black children are less likely to be petitioned for exception scores, have higher waitlist mortality, are less likely to be the recipient of a living donor transplant, and have worse posttransplant outcomes compared with White children. Children living in the most socioeconomically deprived neighborhoods have worse posttransplant outcomes. Children living farther from a transplant center have higher waitlist mortality. Herein we review the current knowledge of these racial and ethnic, socioeconomic, and geographic disparities for these children. To achieve equity, stakeholder engagement is required at all levels from providers and health delivery systems, learning networks, institutions, and society. Future initiatives must be swift, bold, and effective with the tripartite mission to inform policy changes, improve health care delivery, and optimize resource allocation to provide equitable transplant access, waitlist survival, and posttransplant outcomes for all children.

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Section: Addressing Disparities In Pediatric Liver Transplantationmentioning

confidence: 99%

A review of racial, socioeconomic, and geographic disparities in pediatric liver transplantation

Ebel

Lai

Bucuvalas

et al. 2022

Liver Transplantation

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“…11 Dentre os estudos com aumento da doação de órgãos sólidos, um artigo pontua uma mudança de configuração do perfil de doação, com aumento de doadores na faixa etária entre dez e dezoito anos, devido à reconfiguração de dinâmica familiar com o isolamento social. 12 Outro estudo aponta um aumento importante de 54,8% de doadores por morte encefálica, porém, sem especificação do fator causal. 13 Mortalidade na fila de transplante Dos 68 artigos selecionados, um demonstrou redução, quatro demonstraram que não houve alteração e 13 relataram aumento desse volume (Tabela 2).…”

Section: Metodologiaunclassified

“…23 Enquanto o outro apontou acréscimo de 44 dias em relação ao período pré-covid. 12 Em relação aos dois estudos que divergiram, um pontuou que o tempo mínimo de espera aumentou de 112,94 dias para 147,44 e o tempo máximo diminuiu de 260,11 para 195,85 dias. 24 Já em relação ao segundo estudo, o tempo de espera diminuiu em 28 dias para pacientes pediátricos, mas para adultos aumentou em quarenta dias.…”

Section: Lista De Esperaunclassified

Impacto na Fila de Espera dos Transplantes de Órgãos Sólidos Durante a Pandemia de Covid-19: Uma Revisão Integrativa

Costa,

Furtado,

Braga

et al. 2023

BJT

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Introdução: Com a pandemia da Covid-19, muitos procedimentos médicos sofreram alterações significativas devido à realocação de recursos para os pacientes contaminados pelo Sars-Cov-2. A logística de transplantes foi diretamente afetada, com repercussões importantes para o paciente na fila de espera para um novo órgão. Objetivo: Esta revisão busca analisar o impacto da pandemia da Covid-19 na logística de disponibilidade de órgãos sólidos e volume de transplantes. Métodos: Foi realizada uma busca integrativa de artigos com os descritores “Covid OR Sars-Cov-2”, “COVID-19”, “Transplant”, “Donor”, “Waiting list”, “Organ donation” no PubMed e Web of Science. Só foram considerados artigos sobre transplante de pâncreas, coração, fígado, rim e intestino, e que abordassem um dos seguintes tópicos: disponibilidade de doadores, volume e tempo na lista de espera, mortalidade dos pacientes em espera, volume de transplantes realizados. Resultados: Dos 68 artigos encontrados, 49 deles eram multicêntricos. Dentre todos os 68, 29 fizeram alguma colocação em relação ao volume de doador, 42 em relação ao volume de transplante, 18 em relação à mortalidade na fila de transplante, 15 em relação ao volume da lista de espera e quatro em relação ao tempo na lista de espera. Com tais dados, de forma geral, foi possível observar diminuição do volume de doadores e do volume de transplantes, redução de adições à lista de espera, e aumento tanto no tempo de espera para transplantes, quanto na mortalidade do paciente que aguardava pelo transplante. Conclusão: A pandemia da SARS-CoV-2 prejudicou diretamente a logística dos transplantes de órgãos sólidos de forma global. Os motivos que levaram a tal fato estão relacionados à diminuição dos leitos de UTI, contaminação do doador pelo vírus, e protocolos rigorosos para prevenção de transmissibilidade do vírus.

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“…Coronavirus disease 2019 (COVID- 19) has impacted all aspects of health care including solid organ transplantation (SOT). [1][2][3][4][5][6][7][8][9][10][11] The Pfizer-BioNTech BNT 162b2 vaccine first became available under emergency use authorization (EUA) starting in December 2020 and was then approved by the Federal Drug Administration (FDA) for individuals 16 years and older in August 2021. 12,13 Thereafter, the Moderna vaccine and the Pfizer vaccines received EUA for children.…”

Section: Introductionmentioning

confidence: 99%

Survey of pediatric transplant center practices regarding COVID‐19 vaccine mandates for transplant candidates and living donors and use of COVID‐19‐positive deceased organs

Feldman

Beaty

Everitt

et al. 2023

Pediatric Transplantation

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BackgroundCOVID‐19 vaccine is recommended for individuals ages ≥6 months; however, whether vaccination should be mandated for transplant candidates and living donors remains controversial. This study assessed COVID‐19 policies at US pediatric solid organ transplant centers.MethodsA 79‐item survey was emailed between March and April 2022 to 200 UNOS Medical Directors detailing center COVID‐19 vaccine policies for transplant candidates and living donors and use of grafts from COVID‐19‐positive deceased donors.ResultsThe response rate was 77% (154/200). For children aged 5–15 years, 23% (35/154 centers) have a COVID‐19 vaccine mandate, 27% (42/154) anticipate implementing a future mandate, and 47% (72/154) have not considered or do not anticipate implementing a mandate. For children ≥16 years, 32% (50/154 centers) have a COVID‐19 vaccine mandate, 25% (39/154) anticipate implementing a future mandate, and 40% (62/154) have not considered or do not anticipate implementing a mandate. The top two reasons for not implementing a COVID‐19 vaccine mandate were concerns about penalizing a child for their parent's decision and worsening inequities in transplant. Of 85 kidney and liver living donor centers, 32% (27/85) require vaccination of donors. Twenty percent (31/154) of centers accept organs from COVID‐19‐positive deceased donors.ConclusionsThere is great variation among pediatric SOT centers in both the implementation and details of COVID‐19 vaccine mandates for candidates and living donors. To guide more uniform policies, further data are needed on COVID‐19 disease, vaccine efficacy, and use of grafts from donors positive for COVID‐19 in the pediatric transplant population.

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Decreased access to pediatric liver transplantation during the COVID‐19 pandemic

Cited by 8 publications

References 33 publications

A review of racial, socioeconomic, and geographic disparities in pediatric liver transplantation

A review of racial, socioeconomic, and geographic disparities in pediatric liver transplantation

Impacto na Fila de Espera dos Transplantes de Órgãos Sólidos Durante a Pandemia de Covid-19: Uma Revisão Integrativa

Survey of pediatric transplant center practices regarding COVID‐19 vaccine mandates for transplant candidates and living donors and use of COVID‐19‐positive deceased organs

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