I reviewed my post “Thoughts on Transplant Psychiatry” and then looked for research papers that might shed light on other factors relevant to the issue. I found one that was published a year after I wrote this blog post:
Yeturu SK, Lerner SM, Appel JM. Refusal of transplant organs for non-medical reasons including COVID-19 status. Clin Ethics. 2023 Jun;18(2):172-176. doi: 10.1177/14777509221143016. Epub 2022 Dec 1. PMID: 38603250; PMCID: PMC9720467.
The paper focuses on the ethical aspects of refusal by patients of organs for transplant based on non-medical reasons or unrelated medical reasons such as factors like the race or Covid-19 vaccination status of the donor. The authors discuss hypothetical cases, which are thought-provoking and still current. The authors final recommendation is in the discussion section
“Whether preventing racially motivated organ transplant requests or unrelated medical requests such as suicide, there is clear ethical precedent to limiting information sharing to potential organ recipients rooted in donor confidentiality protection as well as organ stewardship. These policies and standard practices, though essential, are insufficient to cover emerging concerns such as that of COVID-19. While a physician cannot in good conscience transplant a known high-risk organ, such as one with a known HCV infection, unwittingly to the patient, other cases of concern for as-yet-unknown risk remain unresolved. Another issue of concern, but one largely beyond the scope of this paper, is that of the decisional capacity of patients making COVID-related transplant requests. Indeed, many cases may arise in which patients rejecting organs based upon transplant status lack such capacity. Our analysis applies to those cases, if and when they arise, when patients do otherwise meet capacity standards. In such cases, waiting for organizations to comfortably create requirements for new vaccines or diseases is too slow to be acceptable for emerging concerns. The only acceptable solution which balances organ stewardship, equity, and patient autonomy is one in which informational requests unrelated to the known quality and risks of an organ are prohibited uniformly by national policy.”
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