Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
Pediatr Nephrol. 2022 Nov;37(11):2559-2569. doi: 10.1007/s00467-022-05511-7. Epub 2022 Mar 25.
The world continues to face the effects of the SARS-CoV-2 pandemic. COVID-19 vaccines are safe and effective in protecting recipients, decreasing the risk of COVID-19 acquisition, transmission, hospitalization, and death. Transplant recipients may be at greater risk for severe SARS-CoV-2 infection. As a result, transplant programs have begun instituting mandates for COVID-19 vaccine for transplant candidacy. While the question of mandating COVID-19 vaccine for adult transplant candidates has garnered attention in the lay and academic press, these discussions have not explicitly addressed children who may be otherwise eligible for kidney transplants. In this paper we seek to examine the potential ethical justifications of a COVID-19 vaccine mandate for pediatric kidney transplant candidacy through an examination of relevant ethical principles, analogous cases of the use of mandates, differences between adult and pediatric kidney transplant candidates, and the role of gatekeeping in transplant vaccine mandates. At present, it does not appear that pediatric kidney transplant centers are justified to institute a COVID-19 vaccine mandate for candidates. Finally, we will offer suggestions to be considered prior to the implementation of a COVID-19 vaccine mandate.
世界仍在继续应对 SARS-CoV-2 大流行的影响。COVID-19 疫苗在保护接种者、降低 COVID-19 感染、传播、住院和死亡风险方面是安全有效的。移植受者可能面临更严重的 SARS-CoV-2 感染风险。因此，移植项目已开始对移植候选者接种 COVID-19 疫苗进行强制要求。虽然 COVID-19 疫苗对成年移植候选人的强制接种问题已经在大众和学术媒体中引起了关注，但这些讨论并没有明确涉及到可能有资格接受肾脏移植的儿童。在本文中，我们通过考察相关伦理原则、类似的授权案例、成人和儿科肾脏移植候选人之间的差异以及把关在移植疫苗授权中的作用，试图探讨对儿科肾脏移植候选者实施 COVID-19 疫苗授权的潜在伦理依据。目前，儿科肾脏移植中心似乎没有理由对候选人实施 COVID-19 疫苗授权。最后，我们将在实施 COVID-19 疫苗授权之前提出一些建议供参考。
