Caregiver COVID-19 vaccination for solid organ transplant candidates

Abstract

An increasing proportion of transplant centers have implemented a mandate for vaccination against COVID‐19 for solid organ transplant candidates. There has been comparatively little exploration of the ethical considerations of mandating vaccination of a candidate's primary caregiver, despite a high risk of transmission given the close nature of contact between the candidate and caregiver. We examine how a caregiver mandate can improve overall utility in organ allocation, particularly in circumstances where vaccine effectiveness at preventing transmission and serious disease is low among recipients but high in caregivers. Our analysis reveals how sensitive such mandates must be to the evolving circumstances of disease severity, transmissibility, and vaccine effectiveness: as the facts change, the degree of benefit gained and therefore the degree of infringement on access to transplant and caregiver choice that is tolerated will likewise change.

Social support and transplantation

“…Although over half of American transplant centers require COVID-19 vaccination for transplant candidates, only 10% require caregivers to be vaccinated and caregiver vaccination remains an ongoing debate [32,33 ▪▪ ]. Sun et al [33 ▪▪ ] summarize the current debate regarding caregiver vaccination and propose that a caregiver vaccination mandate may be justifiable. Caregiver vaccination reduces the risk of COVID-19 transmission to transplant recipients, who are immune suppressed and at increased risk for worse outcomes from COVID-19.…”