Should Unvaccinated Patients Get Organ Transplants?
Hi. I'm Art Caplan. I'm the head of the Division of Medical Ethics at NYU's Grossman School of Medicine in New York City.
There is a huge controversy ongoing about Cincinnati Children's Hospital's decision not to put a 12-year-old girl on their heart transplant waiting list. The reason they didn't do it was thatshe has not been vaccinated against the flu and against COVID-19.
This has led to a huge, angry backlash, part of the reason being that the young girl's mother, Jeneen Deal, is related by marriage to Vice President JD Vance's half-sibling, so she's part of a celebrity family.
The couple — her parents — adopted her from China when she was 4, and they knew at the time that she had heart problems and was going to need a heart transplant. They've always taken her to Cincinnati because they believe that's the best place in their area for her to get care. They've had a long-standing, good relationship with the hospital, and I'm sure they're very angry that now they've got this challenge to getting her waitlisted to receive a heart.
Those of you who know the heart transplant field know that for kids, it's tough to get a heart. It's very difficult because there are very few donors. That's partly because many of the donors for adults come from car accidents, gunshots, swimming pool accidents, that sort of thing. Younger children, happily,are not as likely to die in circumstances where they then become cadaver organ donors, so the organs are very scarce.
What's going on? Well, the family says they don't want to vaccinate because it's against their religious beliefs. It's hard to know what those religious beliefs are because there are no major religions that oppose vaccination.All major religions — all that I'm familiar with — support vaccination as good for the individual to preserve their health and good for the community.
What the hospital is doing in this situation has nothing to do with fights about whether a flu vaccine should be mandated or if schools can require vaccination.What's going on here is that when you get a heart transplant, you have to take immunosuppressive drugs immediately and for the rest of your life.
They tune down your immune system and make you very vulnerable to infections such as the flu, and they make it very likely that you could die if you got the flu, COVID-19, or other infectious diseases that normally we might be able to survive without getting vaccinated.
The hospital is trying to be responsible and say that they don't want her to die if they transplant her. The way to maximize her chance of doing well with the heart is to give her vaccines, which will build up her immune system before they transplant her.
That makes good sense to me. It also makes good sense to say that we don't want to waste a scarce heart on someone who's likely to get sick when other people are waiting in the queue — other kids not related to JD Vance — who are vaccinated and will do better.
From a moral point of view, we want to steward the supply of scarce hearts responsibly and make sure they go to the child who's going to do the best with the heart and has the best chance at life.
I do think it's right to say vaccination, in this instance, is something that the hospital really wants to see.It's medically indicated for this girl and anybody else on a waitlist anywhere for a transplant. That's not the same and shouldn't be mixed up with fights about mandatory vaccination to get into school.
I think the hospital is asking for the right thing, and I hope that they stick to their guns on this oneand don't let misinformation or misunderstanding get in the way of doing what's best for the girl and doing what's best with the scarce supply of hearts.
I'm Art Caplan, at the Division of Medical Ethics at NYU Grossman School of Medicine. Thanks for walking.
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