High-Immunological Risk Living Donor Renal Transplant during the COVID-19 Outbreak: Uncertainties and Ethical Dilemmas

We describe the challenges of performing a high-immunological risk living donor renal transplant during the COVID-19 outbreak. A 42-year-old lady with end-stage renal disease from lupus nephritis had failed peritoneal dialysis due to pleuro-peritoneal leak, failed vascular access creation due to early thrombosis and had recurrent dialysis catheter malfunction. The transplant from her husband was ABO-incompatible and had positive B cell flow crossmatch with multiple donor-specific antibodies. Neither alternative donors nor paired exchange candidates were available. Priority access to deceased donors is limited and unpredictable.