Journal
AMERICAN JOURNAL OF TRANSPLANTATION
Volume 22, Issue 9, Pages 2135-2138Publisher
ELSEVIER SCIENCE INC
DOI: 10.1111/ajt.17078
Keywords
ethics; ethics and public policy; organ allocation; organ procurement and allocation; solid organ transplantation; vaccine
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This article examines ethical considerations of mandating COVID-19 vaccination for primary caregivers of solid organ transplant candidates. It highlights the potential improvement in overall utility in organ allocation and the need for sensitivity to the changing circumstances of disease severity, transmissibility, and vaccine effectiveness.
An increasing proportion of transplant centers have implemented a mandate for vaccination against COVID-19 for solid organ transplant candidates. There has been comparatively little exploration of the ethical considerations of mandating vaccination of a candidate's primary caregiver, despite a high risk of transmission given the close nature of contact between the candidate and caregiver. We examine how a caregiver mandate can improve overall utility in organ allocation, particularly in circumstances where vaccine effectiveness at preventing transmission and serious disease is low among recipients but high in caregivers. Our analysis reveals how sensitive such mandates must be to the evolving circumstances of disease severity, transmissibility, and vaccine effectiveness: as the facts change, the degree of benefit gained and therefore the degree of infringement on access to transplant and caregiver choice that is tolerated will likewise change.
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