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Caregiver COVID-19 vaccination for solid organ transplant candidates

AMERICAN JOURNAL OF TRANSPLANTATION (2022)

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Summary: There is significant heterogeneity in COVID-19 vaccination mandate policies for transplant candidates in US transplant centers. While vaccination is encouraged, most centers have not mandated COVID-19 vaccination for candidates and living donors, citing administrative opposition, legal prohibitions, and concern about equity in access to transplants.

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Summary: The question of whether transplant clinicians should mandate COVID-19 vaccination as a condition of transplant candidacy is complex. While a vaccine mandate may be defensible on safety grounds, it may also lead to a weakening of shared decision-making and exacerbate inequalities in access to transplantation.

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Summary: The authors suggest that requiring healthcare workers and transplant candidates to be vaccinated against COVID-19 is ethically justified based on beneficence, net utility, and fiduciary duty. Implementation strategies should address concerns about autonomy and transparency. This argument could also apply to caregiver vaccination, resource allocation, and mandates for other vaccines. Global equity in vaccination is also emphasized.

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Summary: This article recommends making COVID-19 vaccination a requirement for waitlist activation for solid organ transplant and for the primary member of the in-home support team. These recommendations align with current standard practices but are only controversial due to the heated and politicized public discourse.

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The case against COVID-19 vaccine mandates in pediatric solid organ transplantation

Lainie Friedman Ross et al.

Summary: Mandating COVID-19 vaccination for pediatric solid organ transplant candidates and their households is deemed unethical due to lack of supporting evidence. The risks associated with remaining unvaccinated are relatively low compared to the greater risks of not being listed and transplanted.

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Coronavirus Disease 2019 in Solid Organ Transplant: A Multicenter Cohort Study

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Summary: The mortality rate among SOT recipients hospitalized for COVID-19 was 20.5%, with age and underlying comorbidities being the major drivers of mortality, rather than measures related to immunosuppression intensity.

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The pediatric solid organ transplant experience with COVID-19: An initial multi-center, multi-organ case series

Matthew B. Goss et al.

Summary: This study presents a multi-center, multi-organ cohort analysis of COVID-19-positive solid organ transplant recipients under the age of 18. The findings suggest that pediatric transplant recipients infected with COVID-19 may have outcomes similar to immunocompetent children, with minimal hospitalization and treatment required for symptomatic patients.

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The limits of refusal: An ethical review of solid organ transplantation and vaccine hesitancy

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Summary: Patients undergoing solid organ transplantation should receive multiple vaccines to prevent diseases, but increasing vaccine refusal poses challenges for transplant centers. A uniform national policy addressing vaccine refusal among transplant candidates is needed to establish a consistent approach.

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Outcomes of COVID-19 in Solid Organ Transplant Recipients: A Propensity-matched Analysis of a Large Research Network

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Antibody Response to 2-Dose SARS-CoV-2 mRNA Vaccine Series in Solid Organ Transplant Recipients

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SARS-CoV-2 infection and early mortality of waitlisted and solid organ transplant recipients in England: A national cohort study

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Excluding patients from transplant due to social support: Results from a national survey of transplant providers

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Should Lack of Social Support Prevent Access to Organ Transplantation?

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