A 31-year-old patient at Brigham and Women’s Hospital was removed from a heart transplant waiting list due to a policy that requires people on organ transplant waitlists to have received the COVID-19 vaccine and several other CDC-recommended vaccines.
Art Caplan, director of the division of medical ethics at the New York University School of Medicine, joined Boston Public Radio to discuss why vaccine policies for transplant patients follow best practices in medicine.
The patient’s father, David Ferguson, told CBS Boston that his son, DJ Ferguson, does not believe in the vaccine and that it is “against his basic principles.”
Anti-vaccine advocates have been calling the hospital’s decision discriminatory against unvaccinated people, but Caplan explained that the decision to refuse transplants to unvaccinated patients is typical in the field.
“There are a lot of people don't want to vaccinate who point to this guy and say, ‘You're biased against him, you're discriminating against him,'” Caplan said. “That is not what is going on.”
Because hearts available for transplant are scarce and people often die while on the waiting list, medical providers prioritize patients who have a high chance of survival. Ferguson, who has two children and a third on the way, is relatively young and thus would otherwise be a promising candidate. However, he has not received the COVID-19 vaccine.
Caplan explained that after receiving transplants, patients must take drugs that suppress their immune system so the body accepts the new organ. This makes any type of infection — whether it be the flu, coronavirus or something else — far more dangerous, which is why hospitals often require patients to have a range of vaccinations.
In a statement reported by CBS Boston, Brigham and Women's defended the decision: “Like many other transplant programs in the United States — the COVID-19 vaccine is one of several vaccines and lifestyle behaviors required for transplant candidates in the Mass General Brigham system in order to create both the best chance for a successful operation and also the patient’s survival after transplantation," the hospital said.
Caplan said it makes sense for health providers to give organs to patients who follow medical advice and, thus, have a greater chance of survival.
“This isn’t bias against the unvaccinated, it's sound medical policy, endorsed by the Infectious Disease Society of America [and the] American Society of Transplantation,” he said. “Get vaccinated before you hit the list. That ups your odds.”
He added that Brigham and Women's decision should not be viewed as a question of who will die, but who will live.
After Caplan's appearance, Boston Public Radio took calls from listeners on the topic, including from Tyler in Boston, a 34-year-old who received a heart transplant in December 2019. "This particular story really hits close to me," Tyler said. "The infectious disease doctors, they come in and they tell you everything that you need to take a shot of — and it is a lot of shots ... If Mr. Ferguson is willing to get all these other shots, all these other vaccines, and he's refusing to get the COVID vaccine, I don't think this should be a story."
"I was blessed and I was fortunate, and every day is special for me," Tyler added. "There are a lot of other people that are right behind him that would be blessed and they would be happy to be in this position."
Anne in Shrewsbury, who used to work with transplant patients as an intensive care unit nurse, also said that the waiting list rules are typical. "This story really shouldn't even be a story," Anne said. "There are tight regulations about who gets these organs because they are so rare. ... He's gonna let them open his chest and put a stranger's heart in it and all that goes into that, and yet he won't take a vaccine."
Sue in Hopkinton, who has worked at Brigham and Women's Hospital for the past 20 years, takes care of patients in the cardiology unit pre- and post-transplant.
"COVID has put a completely different spin on this," Sue said. "These patients are so completely immunocompromised after they get the heart. ... I have already seen lung transplants come back, I have seen heart transplants come back with COVID."
Sue said that she now walks into her building and eats lunch to the sound of protesters outside the hospital shouting "Brigham has no heart" on bullhorns.
"It's intimidating when you're walking into work," she said. "What people don't understand is a heart is a gift, it's not a right, and you have to take care of that heart."
