When it comes to receiving organ transplants, patients are not usually judged on prior behavior, but some doctors are questioning whether unvaccinated COVID patients should qualify for new lungs.



The number of lung transplants for COVID patients is rising fast, and that's raising questions about the ethics of allocating scarce organs to people who have chosen not to be vaccinated against the coronavirus. Kerry Sheridan of member station WUSF has this report.

KERRY SHERIDAN, BYLINE: COVID-19 patients now make up 1 in 10 lung transplants in the United States, according to data from the United Network for Organ Sharing, or UNOS.

DAVID KLASSEN: They are accumulating on a steady basis, so it's very much a real thing.

SHERIDAN: That's David Klassen, chief medical officer for UNOS.

KLASSEN: If there were more lungs available for transplants, I believe the numbers would be greater than they are.

SHERIDAN: UNOS's figures show lung transplants for COVID patients rose tenfold between the first year of the pandemic and 2021. Meanwhile, their data also shows transplants for other top lung diseases like emphysema, cystic fibrosis and pulmonary fibrosis so far this year have fallen. David Mulligan, the chair of transplantation at Yale, says it's a troubling trend.

DAVID MULLIGAN: It's happening in the U.S. It's also happening in Canada. There was just a paper out from western Canada about this is causing a huge surge in the number of lung transplants there. It's a big problem.

SHERIDAN: And the operations are expensive, costing around $1.2 million for a double lung transplant. So the rise in COVID-related transplants is forcing doctors to grapple with how to best manage who gets them, especially now that vaccines are widely available. Here's Mulligan again.

MULLIGAN: When somebody contracts such severe COVID, they need a lung transplant. And they got it, refusing to get a vaccine. It's a really ethical dilemma. How can they just jump in and take a lung away from somebody who's sick or has been doing the best they can to take care of themselves and avoid getting COVID?

SHERIDAN: Transplant centers weigh a lot of different factors when listing people who need an organ, but how people came to be sick isn't usually among them. People who smoke can be eligible for a lung transplant, just like people who drink alcohol in excess can also be listed for a new liver, usually if they've stayed smoke-free or sober for six months. Olivia Kates is an assistant professor at Johns Hopkins. She says not judging patient's past behavior is pretty standard in medicine, but future behavior when it comes to transplants is fair game.

OLIVIA KATES: I think they should be subject to the same expectation maybe, that they should either be vaccinated or be able to demonstrate immunity to COVID-19 going forward so that their next set of lungs is not subject to the same risk.

SHERIDAN: Some transplant centers have said patients will lose their spot on the list if they're not vaccinated against coronavirus. But other transplant doctors say eliminating anyone who hasn't had a COVID vaccine from even being considered for an organ may be unfair because it could exclude racial, religious or ethnic groups that tend to have lower vaccination rates. The current system of wait-listing people for transplant prioritizes people who are sickest and have the best chance of being able to benefit and keep the organ, people like 41-year-old Vezna Hang. He got COVID in March of this year, not long after moving to Tampa from New York.

VEZNA HANG: One day, I just looked in the mirror and saw that, you know, my lips and my fingertips were blue.

SHERIDAN: The father of a 5-year-old, Hang was otherwise healthy and had no underlying conditions. Getting COVID caused inflammation in his lungs that led to permanent scars. A transplant was his only option.

HANG: From day to day, you know, there was times that I honestly didn't think I was going to make it. And to leave behind my son - that was heavily on my mind.

SHERIDAN: Hang was not vaccinated when he fell ill with COVID-19. Florida didn't open up vaccine access to his age group, 40 and up, until late March - after he got infected. But Hang understands people who were unsure about getting the shot. He was one of them before he got sick.

HANG: From what I experienced and being inside the hospital setting and seeing all the people that weren't vaccinated being hospitalized, it really made me push to get myself vaccinated, my family and, you know, encourage my friends.

SHERIDAN: Doctors say often, the patients aren't difficult to convince. It's their caregivers who, if unvaccinated, could put a patient's life at risk. That's because people who have a transplant must take immune-suppressing drugs for the rest of their lives to prevent their bodies from rejecting the new organ. For NPR News, I'm Kerry Sheridan in Tampa. Transcript provided by NPR, Copyright NPR.