By Ryan Pferdehirt, D.Bioethics, HEC-C

November 2021

Bioethics case study on vaccination mandates with COVID and organ transplant.

Sonya is 50-years-old, identifies as female, and suffers from end-stage renal failure (ESRD). She is currently on hemodialysis but not tolerating it well. A referring nephrologist believes that Sonya needs a kidney transplant for longer term survival, as well as improved quality of life. The transplant program to which Sonya is referred urges all patients to be fully vaccinated against COVID-19, even though neither their hospital policy nor the transplant program’s candidacy criteria explicitly include mandated COVID vaccination. It is still being discussed, although not much debated.

When counseled to get vaccinated as a matter of optimizing transplant outcomes when immuno-suppressed, Sonya refuses. She doesn’t want “a scary vaccine” and definitely wants to be placed on the transplant list. “I’ll take my chances of getting COVID,” she says.

The renal transplant team is reluctant to proceed. They call for an ethics consult. What should be done?