Liver Transplantation in the Time of COVID19: Barriers and Ethical considerations for Management and Next Steps

Abstract The recent outbreak of the novel virus Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) which causes COVID19 disease has spread globally affecting millions of people This pandemic has taxed our healthcare system and disrupted normal operations, even of lifesaving procedures like liver transplants During these unprecedented times providers and patients are imperiled and resources for diagnosis and care may be limited Continuing to perform resource intense advanced procedures is challenging, as is caring for patients with end-stage liver disease or patients with urgent needs for liver tumor control Liver transplantation in particular requires critical resources like blood products and critical care beds, which are fairly limited in the COVID19 pandemic The potential of COVID19 infections in post-transplant patients on immunosuppression and staff contacts further adds to the complexity Therefore, transplant programs must re-evaluate the ethicality, feasibility, and safety of performing liver transplants during this pandemic Herein, we discuss the clinical and ethical challenges posed by performing liver transplants and offer guidance for managing patients with end-stage liver disease during the COVID19 pandemic