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In January 2022, a controversy emerged in Boston when the family of a 31-year-old man, David DJ Ferguson, protested that a local hospital had removed him from its list of heart transplant recipients, because he had refused to be vaccinated against COVID-19. On Jan. 25, for example, the Daily Mail reported that: Similar articles were published by BBC News, the New York Post, the Daily Beast, and Sky News, among others. Those accounts accurately stated the core facts of the case: Ferguson did require a heart transplant, and Brigham and Women's Hospital did remove him from the recipient list because he refused to get a COVID-19 vaccine. We are issuing a rating of True. However, many reports did not explain well to readers some important pieces of context. Firstly, the decision to remove Ferguson from the transplant list was not part of a new, politicized moral crusade against COVID-19-unvaccinated individuals, in particular. Rather, it was just the latest manifestation of a broader, long-standing approach — set out in professional guidelines — of attempting to maximize the likelihood of a given transplant being successful, by requiring individuals to take certain actions or give up statistically risky behaviors (such as smoking or drinking alcohol) in advance. This ethical imperative becomes even more acute in a scenario where the demand for organ transplants outstrips the supply — meaning some prioritization is unavoidable. Secondly, in principle, Ferguson has the option of applying for a heart transplant with another provider. Though he might encounter similar barriers at other hospitals if he continues to refuse to be vaccinated against COVID-19, this is an important fact that many news reports ought to have included, but did not. Though Brigham and Women's Hospital did not name Ferguson, they repeatedly gave tacit confirmation that they had indeed removed him from the list of would-be recipients, by providing the following statement to various media outlets, including Snopes. In the interests of providing comprehensive context, we're including the full statement here: The key portion of that statement was the one that declared that Brigham and Women's Hospital (BWH) requires several CDC-recommended vaccines, including the COVID-19 vaccine, and lifestyle behaviors for transplant candidates... Patients are not active on the waitlist without this. Since Ferguson has, by his own account, thus far refused any COVID-19 vaccine, there can be little doubt that the hospital had turned down his application, and had done so on that basis. However, BWH's statement did appear to refute one particular claim, namely that Ferguson's name had been at the top of the transplant list. Rather, the hospital wrote, There is no candidate who is 'first on the list' since there are varying levels of priority for allocation of organs. It's worth noting a subtle but important distinction at work here: BWU's decision was likely based not so much on the fact that Ferguson was unvaccinated, but rather that he was refusing to get vaccinated. Brendan Parent, a professor of bioethics at New York University's Grossman School of Medicine, explained to Snopes how hospitals typically give patients the chance to become compliant: Arthur Caplan, also a bioethicist at NYU, told Snopes that COVID-19 vaccine policies such as the one enacted in Ferguson's case did not derive from a battle to penalize the unvaccinated, nor were they made up to discriminate against patients such as Ferguson. Rather, the policies were based on long-standing guidelines issued by the relevant authorities. In October 2021, for example, the American Society of Transplant Surgeons published a position statement on this very subject, which explained the ethical and medical basis for requiring COVID-19 vaccination among would-be transplant recipients. In brief, the ASTS argued that COVID-19 was particularly lethal among transplant recipients, that vaccination helped lower the risks from contracting COVID-19, and that requiring COVID-19 vaccination would simply mean adding one more vaccination to an existing, long-standing list of vaccinations already required for would-be organ transplant recipients. The specific medical reason why transplant recipients were particularly at risk of being infected and sickened with COVID-19 was largely unmentioned in news reports about the plight of Ferguson in January 2022, but it is another important detail here. After transplant surgery, patients are given anti-rejection medicines that are intended to encourage the body to accept a transplanted organ. By definition, these medicines work by suppressing a patient's immune response, meaning they also leave the body exceptionally vulnerable to infection and illness. Thus, hospitals have for many years required would-be transplant recipients to get vaccinated against several diseases, as a prerequisite to surgery. In other words, what is new in this set of circumstances is not so much the introduction of COVID-19 vaccination as a prerequisite for an organ transplant, but rather the extraordinarily high volume of misinformation and disinformation that has been spread about this particular vaccination, as opposed to the others. Finally, another aspect of this story that many outlets did not properly report: the availability of other transplant centers. Each transplant program makes its own decisions about the status of transplant recipients, though they typically follow the same basic ethical guidelines. As such, Ferguson could, in principle, apply to another transplant center, provided he can find one that does not require COVID-19 vaccination as a prerequisite. When applicants are accepted for organ transplant, they get placed on a national list, known as the Organ Procurement and Transplantation Network, where a nonprofit called the United Network for Organ Sharing (UNOS) oversees the entire organ donation system, and seeks to match transplant recipients with the correct donor, and so on. A spokesperson for UNOS explained how transferral between different transplant programs works:
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