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Updated: Sep 29, 2025
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
Considering a COVID-19 vaccine mandate for pediatric kidney transplant candidates
Aaron Wightman1,2, Aviva Goldberg3, Douglas Diekema4,5
1Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA. Aaron.wightman@seattlechildrens.org.
Insights
COVID-19 vaccine mandates for pediatric kidney transplant candidates are not currently justified. Further ethical considerations are needed before implementing such policies for children awaiting kidney transplants.
Area of Science:
- Medical Ethics
- Pediatric Nephrology
- Infectious Disease Epidemiology
Background:
- The SARS-CoV-2 pandemic continues to impact global health.
- COVID-19 vaccines are proven safe and effective, reducing severe illness and death.
- Transplant recipients face higher risks from SARS-CoV-2, leading to vaccine mandates for adult candidates.
Purpose of the Study:
- To examine the ethical justifications for COVID-19 vaccine mandates in pediatric kidney transplant candidates.
- To analyze ethical principles, mandates in analogous cases, and differences between adult and pediatric candidates.
- To evaluate the role of gatekeeping in transplant vaccine mandates.
Main Methods:
- Ethical principle analysis
- Review of analogous mandate cases
- Comparative analysis of adult vs. pediatric transplant candidates
- Examination of gatekeeping in vaccine mandates
Main Results:
- Current ethical justifications do not support COVID-19 vaccine mandates for pediatric kidney transplant candidates.
- Differences between adult and pediatric candidates require distinct ethical considerations.
- Gatekeeping practices in transplant programs warrant careful ethical review.
Conclusions:
- Pediatric kidney transplant centers are not presently justified in instituting COVID-19 vaccine mandates.
- Recommendations for ethical considerations prior to mandate implementation are provided.
- Further discussion is needed on the ethical nuances of pediatric vaccine mandates in transplantation.
Abstract:
The world continues to face the effects of the SARS-CoV-2 pandemic. COVID-19 vaccines are safe and effective in protecting recipients, decreasing the risk of COVID-19 acquisition, transmission, hospitalization, and death. Transplant recipients may be at greater risk for severe SARS-CoV-2 infection. As a result, transplant programs have begun instituting mandates for COVID-19 vaccine for transplant candidacy. While the question of mandating COVID-19 vaccine for adult transplant candidates has garnered attention in the lay and academic press, these discussions have not explicitly addressed children who may be otherwise eligible for kidney transplants. In this paper we seek to examine the potential ethical justifications of a COVID-19 vaccine mandate for pediatric kidney transplant candidacy through an examination of relevant ethical principles, analogous cases of the use of mandates, differences between adult and pediatric kidney transplant candidates, and the role of gatekeeping in transplant vaccine mandates. At present, it does not appear that pediatric kidney transplant centers are justified to institute a COVID-19 vaccine mandate for candidates. Finally, we will offer suggestions to be considered prior to the implementation of a COVID-19 vaccine mandate.
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