Unvaccinated and denied a transplant

Codie Samuelson has been waiting to receive a new kidney for almost four years. But because she is not vaccinated against COVID-19, Vanderbilt University Medical Center removed her from its transplant waiting list last November. Now, four months later, she is planning to get vaccinated because she doesn’t think Vanderbilt will change its policy anytime soon.

Vanderbilt is one of multiple hospital systems denying organ transplants to candidates who aren’t vaccinated against COVID-19. University of Colorado Health (UCHealth), Brigham and Women’s Hospital, Cleveland Clinic, and University of Washington Medical Center have also adopted such a stance. While some patients view the vaccine requirement as unfair, medical ethicists say it reflects a reasonable approach given the risks to transplant patients.

The United Network for Organ Sharing manages the U.S. transplant system but does not regulate individual centers’ criteria for candidates. Several medical organizations encourage U.S. transplant centers to enforce vaccination: In an October 2021 statement, the American Society of Transplant Surgeons recommended vaccination against COVID-19 for transplant candidates, justifying the guideline as consistent with its pre-existing “routine standards of care.” The American Society of Transplantation and the International Society for Heart and Lung Transplantation issued a joint statement in August with similar recommendations. The AST aligns with government advice in also recommending annual flu shots for all U.S. citizens older than 6 months.

Shamgar Connors’ place on the University of Virginia’s kidney transplant waitlist was deactivated in January 2022. He told me he refused COVID-19 vaccination because of his pro-life views. “I’m a Christian dude,” he said. “I know that there’s aborted fetal cells that are in the production, in the manufacturing of these vaccines, all of them, so I don’t want it.” (Abortion-linked fetal cell lines were used in the production of the Johnson & Johnson vaccine and in post-production testing of the Moderna and Pfizer vaccines.)

Born with focal segmental glomerulosclerosis (FSGS), a condition in which scar tissue develops on the kidneys, Connors currently does dialysis 12 hours a night at home. He said that without a kidney transplant, people with his condition can live one to five years on dialysis. His wife set up a GoFundMe fundraiser to pay for legal action against the University of Virginia.

Dennis Hollinger, an ethics professor and president emeritus of Gordon-Conwell Theological Seminary, argues that COVID-19 vaccination optimizes the chances of a successful transplant by reducing the likelihood of severe infection. Organ transplant recipients are placed on immunosuppressant drugs to ward off organ rejection, he explained, making them extremely vulnerable to viral infection of any kind.

Dr. Jeffrey Barrows, senior vice president of bioethics and public policy at the Christian Medical and Dental Associations, echoed Hollinger’s concern about immunosuppression. “I would not only say that the [vaccine] requirement is justified,” he said. “To not require it in this particular circumstance would be endangering a person’s life.” (Barrows believes Christians can receive COVID-19 vaccines without becoming complicit with abortion.)

Hollinger also stressed that the demand for organs is much higher than the supply: In 2021, a little over 40,000 people in the United States received an organ transplant, but the waiting list includes more than 100,000 patients. “We have a triage situation. Who gets the medical goods when there’s not enough to go around?” he said. Hollinger, who also serves on the ethics committee for Atrium Health Carolinas Medical Center in Charlotte, N.C., noted that the organ itself is only one part of the equation hospitals take into account—there’s also the cost and labor required for a transplant surgery.

Emanuela Midolo, a human rights lawyer and visiting scholar at the Kennedy Institute of Ethics at Georgetown University, disagrees. She said the benefits and risks of COVID-19 vaccines are not well enough studied to make them a condition for receiving life-saving care. 

“A person’s unvaccinated status, under the weak state of evidence that we have right now, does not allow us to dispense with the primary rule of medical ethics: ‘First do no harm,’” Midolo wrote for Public Discourse.

Some transplant candidates find their own donor. Leilani Lutali lost her place on UCHealth’s transplant waiting list in October 2021 because she and her kidney donor, Jaimee Fougner, are unvaccinated. Both have avoided the COVID-19 vaccines because of concerns about the abortion-linked fetal cell lines. “Here I am, willing to be a direct donor to her. It does not affect any other patient on the transplant list,” Fougner told CBS Denver. “How can I sit here and allow them to murder my friend when I’ve got a perfectly good kidney and can save her life?”

UCHealth released a statement in October 2021 noting that transplant patients who contract COVID-19 have a 20-30 percent chance of dying, compared with a less than 2 percent chance for the overall population. UCHealth’s vice president of communications, Dan Weaver, cited multiple studies to back up the statistic (including here, here, and here).

Connors already had COVID-19 and believes his natural immunity is sufficient protection against the virus. A study of over 52,000 Cleveland Clinic employees indicated that “until the Omicron variant of COVID-19 emerged, there was no tenable evidence that previously infected individuals benefited substantially from a COVID-19 vaccine for up to 8-10 months.” Samuelson doesn’t think she needs the vaccine either. “I have yet to get COVID,” she said. “If I made it this long without COVID, and I get the vaccine, and I get COVID, I’m going to be very mad.” Neither Connors nor Samuelson were required to receive a flu shot to remain eligible for an organ transplant, they say, although standard childhood vaccines were required.

Asked about exemptions to the vaccine requirement, Hollinger noted that hospitals must generally enact uniform rules. If they make exceptions too easily, chaos might ensue as people come up with various reasons the policy shouldn’t apply to them. “[Hospitals] may have the occasional situation when a team will make a judgment that goes in a different direction,” he said. “But I think that puts hospitals in very vulnerable situations.”