Ethics and Religion Talk: Should an Unvaccinated Person with COVID-19 Receive a Lung Transplant?

About one in 10 lung transplants in the United States now go to COVID-19 patients. When somebody who could have received a vaccination but refused, contracts such severe COVID that they need a lung transplant, should they be allowed to jump in and take a lung away from somebody who has been doing the best they can to take care of themselves and avoid getting COVID, including receiving a vaccination?

The Reverend Colleen Squires, minister at All Souls Community Church of West Michigan, a Unitarian Universalist Congregation, responds:

It is most unfortunate that we find ourselves having to answer these types of questions regarding the Covid vaccine. The misinformation surrounding this vaccine and its safety and effectiveness is heartbreaking. Having worked at major teaching hospitals in Boston for 2 decades prior to being called to ministry, my heart is heavy for all the health care workers. Most enter the profession in hopes of helping people live better lives. While I completely understand the desire to provide care to all patients it is only human nature to see some patients’ behavior as more deserving than others.

Hospitals have a long history of setting up certain ethical criteria standards to determine who is deserving of receiving an organ transplant. For example, a Boston hospital recently removed a potential heart transplant patient from the list due to the patient’s refusal to be vaccinated with the Covid vaccine. The hospital responded by saying, ‘like most transplant programs, certain vaccinations and lifestyle behaviors are required to be considered eligible to be a recipient.’ Vaccinations are even more important following any transplant surgery because of a weakened immune system. For these reasons I would support hospital requiring the Covid vaccine to be required to be placed on the transplant list, it is part of a standard of care. 

The Rev. Steven W. Manskar, a retired United Methodist pastor, responds:

Of course, the ethical response to a person who is suffering severe illness is to provide needed medical treatment. Their vaccination status ought not figure into such decision making. All people are created in the image of God and deserve to be treated with dignity, love, and justice. All people make foolish choices. Some, like refusing to be vaccinated against deadly disease, result in life-threatening illness. Nevertheless, we are obligated to provide treatment to all people who are sick.

Fred Stella, the Pracharak (Outreach Minister) for the West Michigan Hindu Temple, responds:

Of course, this is challenging. The very sad thing about this is that those who have refused vaccination (other than on the sound advice of a physician) have done so due to the misinformation that has been presented to them by many who really do know better, but profit in some way by pretending to hold secret data. I categorically believe that those thought leaders (politicians and broadcasters) who have done their level best to discredit the marvelous work that scientists have done over the past couple of years have committed a tremendous evil. Yes, much blood is on their hands. 

But as to those who, for lack of education or critical thinking skills, have succumbed to their falsehoods and are now in need of major medical intervention, they are upsetting the entire healthcare system. I expect that when it comes to some sort of triage in meting out surgeries and treatments, the refusal of vaccines for reasons other than medical will be taken, along with other factors, into the decision-making process. I would support this.

But I would like to turn this around to the patients themselves. If someone who refused the vaccine and is in need of a transplant to survive, but knows that another person will be short served due to their stubbornness will they take the moral high ground and not allow themselves to take cuts in line?

Linda Knieriemen, Senior Pastor at First Presbyterian Church in Holland, responds:

I confess I have thought this. Isn’t the choice a person makes not to prevent a preventable disease with a vaccination reason to restrict treatment if rationing care is necessary? Is so, then should a life long smoker receive chemo therapy for his lung cancer? A butter, ice cream, prime rib lover a cardiac bypass operation? A life-long runner a knee replacement? We go down a slippery slope when decisions to treat or not treat are made based on individual past behaviors.  Fortunately medical ethics eschews such judgements.

My response:

A number of categories of people end up on the transplant list because of choices they’ve made. For example:

• Those who have destroyed their lungs by smoking
• Those who have destroyed their livers by excessive alcohol consumption
• Those who have abused illegal IV drugs can destroy their heart as well as other organs.

One who continues to engage in the destructive behavior does not qualify for a transplant. However, one who has quit smoking, drinking, or using illegal drugs does qualify. In their case, it would not be ethical to hold the sins of their past against them. We accept their repentance, as it were, as long as we trust that it is sincere and they intend to treat the new organ with better care for their health. Therefore, as long as the unvaccinated person remains unvaccinated, it is consistent with past ethical practice to deny them a transplant.

This column answers questions of Ethics and Religion by submitting them to a multi-faith panel of spiritual leaders in the Grand Rapids area. We’d love to hear about the ordinary ethical questions that come up in the course of your day as well as any questions of religion that you’ve wondered about. Tell us how you resolved an ethical dilemma and see how members of the Ethics and Religion Talk panel would have handled the same situation. Please send your questions to [email protected].