Ethicists Back Hospitals Denying Organ Transplant In Unvaccinated Patients

The denial of a heart transplant to a man who is unvaccinated for COVID-19 at a Boston hospital has sparked national attention, but experts say mandating vaccines is consistent with other long-standing requirements that patients must meet in order to receive an organ transplant, such as getting other shots.

DJ Ferguson, 31, is in need of a new heart, but Brigham and Women's Hospital in Boston has removed him off their waiting list, according to his father, David. He said that the COVID vaccine violates his son's "basic principles; he doesn't believe in it."

The hospital stated that it was following policy.

Patients' privacy laws prevented Brigham and Women's Hospital from commenting on Ferguson's case. However, it highlighted a comment on its website that said that the COVID-19 vaccine is one of several immunizations recommended by most U.S. transplant programs, which also include a flu shot and hepatitis B vaccines.

The hospital stated that research has indicated that transplant recipients are at a higher risk of dying from COVID-19 than non-transplant patients, and that its practices are in line with the American Society of Transplantation and other health organizations' recommendations.

Perhaps as a result of the politicization of COVID-19 vaccines in general, such decisions are occasionally regarded with resentment. However, ethicists and transplant doctors argue that organ allocation must be influenced in part by who can survive and thrive with a limited resource.

With so many patients waiting for an organ, physicians strive to increase the likelihood of a successful transplant. Hospitals do not want to give an organ to someone who puts themselves at a higher risk of dying following a transplant, especially since that organ cannot later be given to someone else.

"The entire transplant evaluation process, which can be very long and very demanding, is about making sure patients are in the best physical, mental, and social condition to endure a transplant, and then all the downstream effects of transplantation," Olivia Kates, a Johns Hopkins infectious diseases physician who specializes in transplant patients, told Stat News.

The coronavirus is also far more common than other infections that pose a threat to transplant patients (with a possible exception being influenza during its seasonal peaks).

Experts emphasize that transplant recipients should be vaccinated before receiving a new organ since they have problems developing a robust immune response to vaccines as a result of their immunosuppressive treatments.

"We strongly recommend that all eligible children and adult transplant candidates and recipients be vaccinated" against COVID-19, the American Society of Transplant Surgeons, the American Society of Transplantation, and the International Society for Heart & Lung Transplantation said in a joint statement.

Kates, a bioethicist who researches vaccine policy, said there was no reliable estimate for the percentage of transplant hospitals that had previously imposed a COVID-19 vaccination mandate, but that the number was expanding as more centers implemented rules.

If a patient is denied care at one hospital, he or she may attempt to seek care at another facility.