There was a ten-fold increase in the number of COVID-19 patients receiving lung transplants in the United States between August 2020 and October 2021. During this period, the United Network for Organ Sharing (UNOS) reports 238 COVID-19 patients received new lungs, equal to roughly 10% of all lung transplants, and the number keeps growing in both the U.S. and Canada. 

As COVID-related lung transplants have been rising, transplants for people with other pressing lung diseases, like emphysema and pulmonary fibrosis, have declined compared to previous years. This opposing trend is causing experts to question whether such a scarce resource should be given to people choosing not to get a coronavirus vaccine when there are those doing all they can to protect themselves against COVID-19.

A New Ethical Dilemma

In deciding whether someone qualifies for an organ transplant, social factors and past high-risk behaviors are typically not considered in the interest of fairness. A history of smoking would not disqualify someone for a new lung, for instance. In the case of COVID-19, however, refusal to get vaccinated could jeopardize the health of a new lung, bringing into question whether future behavior should be considered for qualification.

“Future behavior, when it comes to transplants, is fair game. I think [COVID-19 patients] should be subject to the same expectation, that they should either be vaccinated or be able to demonstrate immunity to COVID-19 going forward so that their next set of lungs is not subject to the same risk,” said Olivia Gates, an assistant professor of medicine at Johns Hopkins. 

The current system of waitlisting people for transplant strives for equity and prioritizes “people who can’t wait much longer for their organ, but if they get one, they have a good chance of being able to benefit and keep that organ,” the University of Denver’s Govind Persad, a professor of bioethics and health law explained.

Some transplant programs are already disqualifying COVID-19 patients for refusal to get vaccinated, like Colorado’s UCHealth system. Others, however, point to possible discrimination against racial, ethnic, and religious groups with lower immunization rates.

Caregivers Often Most Resistant

For 41-year-old Venza Hang of Tampa, father to a five-year-old boy, lung transplantation was the only remaining treatment option for his COVID diagnosis. Venza is fortunate he was able to qualify and receive a lung transplant despite not being vaccinated since vaccine access didn’t open up for his age group in Florida until March 2021. Though he understands why people may be hesitant to get vaccinated, since he was once part of that group, he now encourages family and friends to also get protected against COVID-19.

Hang’s personal story ended well, but clinicians say caregivers of transplant recipients who refuse to get vaccinated can often undermine public health efforts, with individuals developing serious COVID-19 from unvaccinated family members.

Weakened Immunity

Organ recipients typically have weakened immune systems from the anti-rejection medication they have to take for the rest of their lives. Coupled with the recent emergence of more contagious variants, such as Omicron and Delta, transplant patients are at higher risk for severe illness if infected.

While there are currently no national guidelines on dealing with vaccine refusal, the American Society of Transplant Surgeons advises that anyone on a transplant list get vaccinated beforehand (not afterward) for stronger protection following surgery.

*Sheridan, K. (2021, November 28). Once rare, lung transplants for COVID-19 patients are rising quickly. NPR. https://www.npr.org/2021/11/28/1058988220/once-rare-lung-transplants-for-covid-19-patients-are-rising-quickly

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