Coronavirus Vaccination and Organ Transplantation

As the “novel” coronavirus becomes “novel” no more, protocol with regard to how institutions and governing bodies operate and take health precautions will continue to spark social controversy. Especially, one might add, when the coronavirus affects areas of life that we would not previously think would be affected. One such case is that of COVID-19 vaccination status when deciding which transplant candidates are the rightful receivers of sought-after transplants, such as a kidney or liver. Various hospitals around the United States have begun to require vaccination as part of eligibility for an organ transplant, and this decision has turned into yet another controversy about COVID-19. When receiving a transplant, the patient’s immune system is severely immunocompromised, and contracting an illness (like COVID-19) becomes increasingly likely when not taking the necessary precautions.

This debate was brought to light when Leilani Lutali, a kidney patient from Colorado, refused to get vaccinated against COVID-19, and was, therefore, reported inactive on a kidney waiting list at the University of Colorado Hospital. Her refusal stemmed from religious objections and overall discomfort about taking the vaccine, and if she didn’t start her vaccination process within the month, she would then lose her spot on the waiting list completely. Lutali would then proceed to seek care from institutions that don’t require COVID-19 vaccination in order to receive a transplant, in the hopes of getting off the waiting list there. Though Lutali offered to be tested for COVID-19 before the transplant surgery, as well as absolve the hospital of all responsibility of the risk of her not taking the vaccine prior to the procedure, she was turned down, disappointed that her own decisions toward her health were not taken into account.

Those who agree with Lutali would argue that the patient’s religious limitations and risks should be respected and should not affect her ability to receive service at the hospital. However, a key aspect of a this procedure includes concern for other prospective transplant receivers, a consideration that can change the course of hospital policy. With 107,000 candidates waiting for an organ transplant in the US, concern for the “other” in this process is paramount.

The code of ethics of the American Society of Transplantation offers some insight into how hospitals and other medical institutions dealing with transplants might decide who their patients may be. Because transplants of any kind are so coveted and, therefore, limited, this code of ethics is assumed to be an objective triage process when it comes to decision making in an area that can seem so subjective. The AST makes it clear that “Medical criteria must be the primary determining factors in transplant decision-making,” and all else is secondary. When choosing organ recipients, institutions must also consider the likelihood of a successful transplantation. This code of ethics was established before COVID-19, and many hospitals require vaccination against other diseases as a prerequisite to receiving an organ transplant, anyway. It isn’t a new idea that transplant patients must work to become fit to receive a transplant— for example, smokers refrain from smoking for six months before receiving a lung transplant.

Religious beliefs should be respected (as affirmed by the AST), but a patient whose religious beliefs infringe upon the health of other patients should not be prioritized in this process. When others’ lives are at stake, it is understood that restrictions must be placed. This is not to say that an unvaccinated person should not receive a transplant, but they should not be directly prioritized over another patient when they are inherently at a lower chance of success for the operation. In such an area of medicine where supplies are increasingly limited, medical criteria must be able to adapt to the changing times while staying true to our code of ethics. In this case, it means that requiring a COVID-19 vaccine to receive an organ transplant is a valid and scientifically supported criterion when deciding who should receive a transplant. Therefore, coronavirus vaccinations should be required for patients who wish to undergo organ transplantation. This isn’t a “novel” discussion anymore; it is rightfully rooted in past decisions. As the medical world continues to evolve in all areas, it is this evaluation of precedent, ethical practice, and new circumstances that will contribute to the most informed decisions.

References

[1] Aleccia, J. N. (2021, October 8). Organ centers to transplant patients: Get a Covid vaccine or move down on Waitlist. NBCNews.com. Retrieved November 4, 2021, from https://www.nbcnews.com/health/health-news/organ-centers-transplant-patients-get-covid-vaccine-or-move-down-n1281084

[2] American Society of Transplantation. (2018, November 14). AST statement on ethics in organ transplantation. American Society of Transplantation. Retrieved November 4, 2021, from https://www.myast.org/about-ast/who-we-are/strategic-plan-our-mission/ast-statement-ethics-organ-transplantation

[3] Taylor, D. B. (2021, October 6). The choice for a Colorado patient: Get vaccinated, or miss out on a kidney transplant. The New York Times. Retrieved November 4, 2021, from https://www.nytimes.com/2021/10/06/us/covid-vaccine-kidney-transplant.html