Ethics of kidney care in the era of COVID-19

Martin, Dominique E.; Parsons, Jordan A.; Caskey, Fergus; Harris, David C.H.; Jha, Vivekanand

The COVID-19 pandemic presents significant challenges for health systems globally, including substantive ethical dilemmas that may pose specific concerns in the context of care for people with kidney disease. Ethical concerns may arise as changes to policy and practice impact on the ability of all health professionals to fulfil their ethical duties towards their patients in providing best practice care. In this paper we briefly describe such concerns and elaborate on issues of particular ethical complexity in kidney care: equitable access to dialysis during pandemic surges; balancing the risks and benefits of different kidney failure treatments, specifically with regards to suspending kidney transplantation programs and prioritizing home dialysis, and barriers to shared-decision making; and ensuring ethical practice when using unproven interventions. We present preliminary advice on how to approach these issues and recommend urgent efforts to develop resources that will support health professionals and patients in managing them.