{"id":39,"date":"2022-09-16T19:27:42","date_gmt":"2022-09-16T19:27:42","guid":{"rendered":"https:\/\/pressbooks.palni.org\/prindlepost\/?post_type=chapter&p=39"},"modified":"2022-09-30T19:41:16","modified_gmt":"2022-09-30T19:41:16","slug":"the-heartless-matter-of-organ-transplantation-covid-vaccination","status":"publish","type":"chapter","link":"https:\/\/pressbooks.palni.org\/prindlepost\/chapter\/the-heartless-matter-of-organ-transplantation-covid-vaccination\/","title":{"raw":"The Heartless Matter of Organ Transplantation COVID Vaccination","rendered":"The Heartless Matter of Organ Transplantation COVID Vaccination"},"content":{"raw":"
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Are those who have been vaccinated more deserving recipients of organ transplant than those who have not?<\/h5>\r\n<\/header>\r\n
\r\n
\r\n
Before reading: Should vaccination status play a role in determining who receives an organ transplant? Draw and label the scale below in your notes. Place yourself more toward the left side of the scale if you think we should prioritize those who are vaccinated on organ recipient lists. Place yourself more toward the right side of the scale if you think we shouldn\u2019t hold people\u2019s vaccination status against them.<\/h5>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n\"\"\r\n\r\n<\/header><\/div>\r\n
Stakeholder Map Prompt: Using the instructions from \"How to Create and Use a Stakeholder Map<\/a>,\" create a stakeholder map in your notes, either individually or with your class. Show the topic, the subjects affected, and possible outcomes based on the ideas introduced at the beginning of this article and your own background knowledge of the topic.<\/div>\r\nBoston\u2019s Brigham and Women\u2019s Hospital has removed one of its patients from its transplant list because he refuses to get the COVID-19 vaccination. 31-year-old DJ Ferguson, who suffers from a hereditary heart issue that causes his lungs to fill with blood and fluid, had previously been prioritized for a life-saving heart transplant. However, according to his family, he has been removed from the transplant list due to his vaccine hesitancy. DJ\u2019s father, David Ferguson, said<\/a>, \u201c[i]t\u2019s kind of against his basic principles; he doesn\u2019t believe in it. It\u2019s a policy they are enforcing and so because he won\u2019t get the shot, they took him off the list [for] a heart transplant.\u201d DJ\u2019s family are currently considering moving him to another facility but are unsure whether he would survive the trip.\r\n\r\nThe fair distribution of scarce resources has been an issue throughout the pandemic. For example, in its early days, there was considerable discussion about distributing life-saving ventilators when the number of people needing them outstripped hospital reserves. States such as Alabama<\/a>, Kansas<\/a>, and Tennessee<\/a> all produced guidance recommending, suggesting, or explicitly stating that a patient\u2019s disability status could be considered a reason to withhold \u2014 or even withdraw \u2014 ventilation. In other words, they deprioritized the disabled in favor of the non-disabled. This problem has, to a degree, eased with the development of effective vaccines and the production of more ventilators.\r\n\r\nHowever, unlike ventilators, we cannot simply manufacture more bodily organs, such as hearts (at least, not yet<\/a>). The supply of hearts is dictated by how many people donate them. Unlike other donatable organs, like kidneys or livers, donating a heart isn\u2019t something one can do as a kind act during their lifetime. If you\u2019re donating your heart, you\u2019re already dead. As such, hearts are incredibly precious resources. They possess value born from the life that the donor no longer lives and the organ\u2019s potential for its recipient \u2013 heart transplantation both takes and awards life.\r\n\r\nBecause someone must die for a transplantable heart to be made available, there is rightfully an ethical imperative to ensure that the \u2018right\u2019 person receives the organ. Giving such a vital and scarce resource to someone who would treat it improperly squanders its potential and disrespects the person who donated the organ. Turk, from the sitcom \u201cScrubs,\u201d summarizes this well when he refuses to perform surgery on another character\u2019s longtime patient when he finds out that the person has continued to drink, saying<\/a>:\r\n\r\nDr. Cox, I know it\u2019s really hard on you medical guys, because you spend most of your time with your patients and you get emotionally attached. But as a surgeon, the person I\u2019m closest to is the guy who\u2019s giving us the liver, because it\u2019s a gift, and I think it\u2019s important that it goes to the person that\u2019s proven they\u2019re up to the responsibility.\r\n\r\nWhile the phrase \u2018responsibility\u2019 clouds the water here somewhat, the general message remains the same: some people are more deserving of organs than others. While we may wish to save everyone, this isn\u2019t possible given the global shortage of organs. Roughly 17 people die each day<\/a> because of a lack of organs in the U.S. alone. So for each person who receives an organ, there are numerous others deemed less worthy who must miss out.\r\n\r\nIn \u201cScrubs,\u201d it comes down to a matter of responsibility and the ability of potential recipients to demonstrate they will treat the organ with the regard it demands. In a sense, they have to earn that organ. In DJ Ferguson\u2019s case, the point of contention is slightly different. As Arthur Caplan, Head of Medical Ethics at NYU Grossman School of Medicine, states<\/a>, \u201cOrgans are scarce, we are not going to distribute them to someone who has a poor chance of living when others who are vaccinated have a better chance post-surgery of surviving.\u201d So, the concern here isn\u2019t whether Ferguson\u2019s shown he is responsible enough (although you could make a case that his actions demonstrate he isn\u2019t). Instead, it is simply a matter of maximizing outcomes and minimizing risks. Being vaccinated against COVID-19 means you\u2019re less likely to die from the disease, and a reduction in this risk improves the chances of getting the best \u2018value-for-money\u2019.\r\n\r\nPinning so much on the vaccination status of a potential organ receipt might strike some as odd. After all, there are countless ways to act that might jeopardize an organ\u2019s recipient but which would seem unreasonable to use as exclusion criteria (denying a transplant to someone who enjoys extreme sports, for example). However, it is essential to remember that individuals are at substantial risk from infections post-transplantation as their immune systems are compromised. This is because the body\u2019s immune system sees donated organs as a foreign entity that must be destroyed, causing organ rejection. To help prevent this, organ recipients take drugs to suppress their immune systems. While allowing successful organ implantation, it means that the recipient is at greater risk from infections. Even something as innocuous as a cold can be fatal, and the same goes for COVID-19. With this increased risk comes an accompanying increase in the threat posed to the positive outcome of transplantation. Therefore, a vaccinated person is a much less risky investment than a non-vaccinated person. Given our interest in maximizing the benefits someone will receive from a donated organ, it seems reasonable (even prudent) to make vaccination a requirement for anyone to receive an organ.\r\n\r\nDavid Ferguson has said his son \u201cis fighting pretty damn courageously, and he has integrity and principles he really believes in, and that makes me respect him all the more\u2026 It\u2019s his body. It\u2019s his choice.\u201d David may be right. His son may indeed be acting bravely by exercising his right to bodily autonomy in a dire situation, which might make him deserving of respect. But this does little to change the fact that, when deciding who should receive a heart transplant, DJ is a risky investment. If we\u2019re concerned with making sure that the consequences of a transplant are as positive as possible \u2014 \u201cpositive\u201d meaning conferring the most amount of life \u2014 then it seems like a person\u2019s choice to be unvaccinated must be taken into consideration.\r\n
\r\n
Respond to the following questions in your notes and through classroom discussion.<\/h5>\r\n
    \r\n \t
  1. We often require that alcoholics be sober for at least 6 months before being eligible to receive a kidney transplant. Is this regulation more or less justifiable than denying someone an organ because they haven\u2019t been vaccinated?<\/li>\r\n \t
  2. The author suggests that deciding who should receive an organ transplant is \u201csimply a matter of maximizing outcomes and minimizing risks.\u201d But what specific kinds of outcomes and risks should we consider? What other kinds of considerations might make one \u201cmore deserving\u201d (age, health, lifestyle, job, family)?<\/li>\r\n \t
  3. Given the grave consequences of DJ\u2019s refusal to be vaccinated, can we really say that he has the opportunity to exercise autonomous choice? Should the fact that DJ appears to be coerced give us reason to reconsider this policy?<\/li>\r\n<\/ol>\r\n<\/div>\r\n ","rendered":"
    \n
    \n
    <\/div>\n<\/header>\n
    \n
    Are those who have been vaccinated more deserving recipients of organ transplant than those who have not?<\/h5>\n<\/header>\n
    \n
    \n
    Before reading: Should vaccination status play a role in determining who receives an organ transplant? Draw and label the scale below in your notes. Place yourself more toward the left side of the scale if you think we should prioritize those who are vaccinated on organ recipient lists. Place yourself more toward the right side of the scale if you think we shouldn\u2019t hold people\u2019s vaccination status against them.<\/h5>\n<\/div>\n<\/div>\n<\/div>\n
    \"\"<\/div>\n
    Stakeholder Map Prompt: Using the instructions from “How to Create and Use a Stakeholder Map<\/a>,” create a stakeholder map in your notes, either individually or with your class. Show the topic, the subjects affected, and possible outcomes based on the ideas introduced at the beginning of this article and your own background knowledge of the topic.<\/div>\n

    Boston\u2019s Brigham and Women\u2019s Hospital has removed one of its patients from its transplant list because he refuses to get the COVID-19 vaccination. 31-year-old DJ Ferguson, who suffers from a hereditary heart issue that causes his lungs to fill with blood and fluid, had previously been prioritized for a life-saving heart transplant. However, according to his family, he has been removed from the transplant list due to his vaccine hesitancy. DJ\u2019s father, David Ferguson, said<\/a>, \u201c[i]t\u2019s kind of against his basic principles; he doesn\u2019t believe in it. It\u2019s a policy they are enforcing and so because he won\u2019t get the shot, they took him off the list [for] a heart transplant.\u201d DJ\u2019s family are currently considering moving him to another facility but are unsure whether he would survive the trip.<\/p>\n

    The fair distribution of scarce resources has been an issue throughout the pandemic. For example, in its early days, there was considerable discussion about distributing life-saving ventilators when the number of people needing them outstripped hospital reserves. States such as Alabama<\/a>, Kansas<\/a>, and Tennessee<\/a> all produced guidance recommending, suggesting, or explicitly stating that a patient\u2019s disability status could be considered a reason to withhold \u2014 or even withdraw \u2014 ventilation. In other words, they deprioritized the disabled in favor of the non-disabled. This problem has, to a degree, eased with the development of effective vaccines and the production of more ventilators.<\/p>\n

    However, unlike ventilators, we cannot simply manufacture more bodily organs, such as hearts (at least, not yet<\/a>). The supply of hearts is dictated by how many people donate them. Unlike other donatable organs, like kidneys or livers, donating a heart isn\u2019t something one can do as a kind act during their lifetime. If you\u2019re donating your heart, you\u2019re already dead. As such, hearts are incredibly precious resources. They possess value born from the life that the donor no longer lives and the organ\u2019s potential for its recipient \u2013 heart transplantation both takes and awards life.<\/p>\n

    Because someone must die for a transplantable heart to be made available, there is rightfully an ethical imperative to ensure that the \u2018right\u2019 person receives the organ. Giving such a vital and scarce resource to someone who would treat it improperly squanders its potential and disrespects the person who donated the organ. Turk, from the sitcom \u201cScrubs,\u201d summarizes this well when he refuses to perform surgery on another character\u2019s longtime patient when he finds out that the person has continued to drink, saying<\/a>:<\/p>\n

    Dr. Cox, I know it\u2019s really hard on you medical guys, because you spend most of your time with your patients and you get emotionally attached. But as a surgeon, the person I\u2019m closest to is the guy who\u2019s giving us the liver, because it\u2019s a gift, and I think it\u2019s important that it goes to the person that\u2019s proven they\u2019re up to the responsibility.<\/p>\n

    While the phrase \u2018responsibility\u2019 clouds the water here somewhat, the general message remains the same: some people are more deserving of organs than others. While we may wish to save everyone, this isn\u2019t possible given the global shortage of organs. Roughly 17 people die each day<\/a> because of a lack of organs in the U.S. alone. So for each person who receives an organ, there are numerous others deemed less worthy who must miss out.<\/p>\n

    In \u201cScrubs,\u201d it comes down to a matter of responsibility and the ability of potential recipients to demonstrate they will treat the organ with the regard it demands. In a sense, they have to earn that organ. In DJ Ferguson\u2019s case, the point of contention is slightly different. As Arthur Caplan, Head of Medical Ethics at NYU Grossman School of Medicine, states<\/a>, \u201cOrgans are scarce, we are not going to distribute them to someone who has a poor chance of living when others who are vaccinated have a better chance post-surgery of surviving.\u201d So, the concern here isn\u2019t whether Ferguson\u2019s shown he is responsible enough (although you could make a case that his actions demonstrate he isn\u2019t). Instead, it is simply a matter of maximizing outcomes and minimizing risks. Being vaccinated against COVID-19 means you\u2019re less likely to die from the disease, and a reduction in this risk improves the chances of getting the best \u2018value-for-money\u2019.<\/p>\n

    Pinning so much on the vaccination status of a potential organ receipt might strike some as odd. After all, there are countless ways to act that might jeopardize an organ\u2019s recipient but which would seem unreasonable to use as exclusion criteria (denying a transplant to someone who enjoys extreme sports, for example). However, it is essential to remember that individuals are at substantial risk from infections post-transplantation as their immune systems are compromised. This is because the body\u2019s immune system sees donated organs as a foreign entity that must be destroyed, causing organ rejection. To help prevent this, organ recipients take drugs to suppress their immune systems. While allowing successful organ implantation, it means that the recipient is at greater risk from infections. Even something as innocuous as a cold can be fatal, and the same goes for COVID-19. With this increased risk comes an accompanying increase in the threat posed to the positive outcome of transplantation. Therefore, a vaccinated person is a much less risky investment than a non-vaccinated person. Given our interest in maximizing the benefits someone will receive from a donated organ, it seems reasonable (even prudent) to make vaccination a requirement for anyone to receive an organ.<\/p>\n

    David Ferguson has said his son \u201cis fighting pretty damn courageously, and he has integrity and principles he really believes in, and that makes me respect him all the more\u2026 It\u2019s his body. It\u2019s his choice.\u201d David may be right. His son may indeed be acting bravely by exercising his right to bodily autonomy in a dire situation, which might make him deserving of respect. But this does little to change the fact that, when deciding who should receive a heart transplant, DJ is a risky investment. If we\u2019re concerned with making sure that the consequences of a transplant are as positive as possible \u2014 \u201cpositive\u201d meaning conferring the most amount of life \u2014 then it seems like a person\u2019s choice to be unvaccinated must be taken into consideration.<\/p>\n

    \n
    Respond to the following questions in your notes and through classroom discussion.<\/h5>\n
      \n
    1. We often require that alcoholics be sober for at least 6 months before being eligible to receive a kidney transplant. Is this regulation more or less justifiable than denying someone an organ because they haven\u2019t been vaccinated?<\/li>\n
    2. The author suggests that deciding who should receive an organ transplant is \u201csimply a matter of maximizing outcomes and minimizing risks.\u201d But what specific kinds of outcomes and risks should we consider? What other kinds of considerations might make one \u201cmore deserving\u201d (age, health, lifestyle, job, family)?<\/li>\n
    3. Given the grave consequences of DJ\u2019s refusal to be vaccinated, can we really say that he has the opportunity to exercise autonomous choice? Should the fact that DJ appears to be coerced give us reason to reconsider this policy?<\/li>\n<\/ol>\n<\/div>\n

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