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

Lainie Friedman Ross1,2,3, Douglas J Opel4,5

  • 1Department of Pediatrics, University of Chicago, Chicago, IL, USA.

Pediatric Transplantation
|February 12, 2022
PubMed

Insights

Mandating COVID-19 vaccination for pediatric solid organ transplant (SOT) candidates and their households is not ethically justifiable. The potential harm of denying transplantation outweighs the risks associated with remaining unvaccinated.

Area of Science:

  • Pediatric Ethics
  • Transplant Medicine
  • Infectious Disease Control

Background:

  • Joint statements recommend COVID-19 vaccination for solid organ transplant (SOT) recipients and close contacts.
  • Some SOT programs mandate vaccination for listing and transplantation.

Purpose of the Study:

  • To ethically evaluate the justification for mandating COVID-19 vaccination in pediatric SOT candidates.
  • To assess the ethical implications of vaccine mandates for SOT candidates, their support persons, and households.

Main Methods:

  • Utilized current best evidence and moral theory.
  • Examined ethical justifications for vaccine mandates in pediatric populations.
  • Applied principles to the SOT context, considering disease prevention and resource stewardship.

Main Results:

  • Vaccine mandates are justifiable for serious vaccine-preventable diseases with high transmission and no less intrusive alternatives.
  • Stewardship of scarce transplant resources can justify mandates if graft loss is a significant risk.
  • Current evidence does not support these criteria for pediatric SOT and COVID-19 vaccination.

Conclusions:

  • Contingent listing on COVID-19 vaccination for pediatric SOT candidates is ethically problematic.
  • The risk of harm from not being listed for transplantation outweighs the risks of remaining unvaccinated.
Abstract

Keywords:
ethicsparental dismissaltransplantationvaccine mandatesvaccine refusalwaitlisting

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