Exploring the ethical complexity of pediatric organ transplant candidates and COVID‐19 vaccination: Tensions between autonomy and beneficence, children and parents

• Published in: Pediatric transplantation Vol. 27; no. 1; pp. e14408 - n/a
• Main Authors: Lara Carrion, Libia, Bramstedt, Katrina A.
• Format: Journal Article
• Language: English
• Published: Denmark Wiley Subscription Services, Inc 01.02.2023; John Wiley and Sons Inc
• Subjects: Autonomy; Beneficence; Child; COVID-19; COVID-19 - prevention & control; COVID-19 vaccines; COVID-19 Vaccines - therapeutic use; Ethics; Humans; Immunization; Organ Transplantation; Pandemics; Parents; Pediatrics; Post-Acute COVID-19 Syndrome; Regulatory approval; Tissue and Organ Procurement; Transplant Recipients; Transplantation; Transplants & implants; Vaccination; vaccine mandates; vaccine refusal; Viewpoint; Viewpoints; COVID-19; vaccine refusal; ethics; pediatrics; transplantation; vaccine mandates
• ISSN: 1397-3142; 1399-3046
• DOI: 10.1111/petr.14408

Background POT is emotionally sensitive due to cohort vulnerability, their lack of decisional capacity, and waitlist mortality. The COVID‐19 pandemic has added complexity to the setting of pediatric transplantation, as well as living donation, due to tensions about COVID‐19 vaccination for recipients, donors, and parent‐caregivers. Methods In the context of COVID‐19 vaccination, two ethicists present four pediatric donation and transplant dilemmas for ethical exploration and offer guidance to clinical teams, noting that mandates are controversial, and there is no global harmonization regarding requirements. Results As with all vaccinations, they are a tool of organ stewardship aimed to optimize outcomes and, in the setting of pediatrics, ensure optimal caregiving for these vulnerable recipients. Current evidence supports the ethical permissibility of COVID‐19 vaccination mandates for transplant candidates aged 6 months and older. Conclusion Our guidance considers the tensions of autonomy and beneficence and the ethical duty of organ stewardship. The harms of being unvaccinated and risking the harms of COVID‐19 and long‐COVID post‐transplant support the ethical permissibility of vaccination mandates in countries where the vaccine has pediatric regulatory approval.