Department of Pediatrics, University of Washington, Seattle, Washington, USA.
Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital, Seattle, Washington, USA.
Am J Transplant. 2022 Sep;22(9):2135-2138. doi: 10.1111/ajt.17078. Epub 2022 May 7.
An increasing proportion of transplant centers have implemented a mandate for vaccination against COVID-19 for solid organ transplant candidates. There has been comparatively little exploration of the ethical considerations of mandating vaccination of a candidate's primary caregiver, despite a high risk of transmission given the close nature of contact between the candidate and caregiver. We examine how a caregiver mandate can improve overall utility in organ allocation, particularly in circumstances where vaccine effectiveness at preventing transmission and serious disease is low among recipients but high in caregivers. Our analysis reveals how sensitive such mandates must be to the evolving circumstances of disease severity, transmissibility, and vaccine effectiveness: as the facts change, the degree of benefit gained and therefore the degree of infringement on access to transplant and caregiver choice that is tolerated will likewise change.
越来越多的移植中心已经实施了针对实体器官移植候选人接种 COVID-19 疫苗的规定。尽管由于候选人和照顾者之间密切接触，传播风险很高，但对于授权接种候选者的主要照顾者的疫苗的伦理考虑相对较少。我们研究了照顾者授权如何能够提高器官分配的整体效用，特别是在疫苗对接受者的传播和严重疾病的预防效果较低但对照顾者的效果较高的情况下。我们的分析揭示了此类授权必须对疾病严重程度、传染性和疫苗有效性的不断变化的情况有多么敏感：随着事实的变化，获得的益处程度以及因此可以容忍的对移植和照顾者选择的访问的侵犯程度也将随之变化。
