Government COVID-19 vaccine mandates, at the federal and state level, have taken center stage in America’s national debate. The imposition of such mandates has raised a series of thorny ethical, legal, and practical questions, including personal freedom and autonomy, the role of natural immunity, the legitimate reach of government power, and problems related to private business enforcement of a government program.

In healthcare settings where the stakes are life and death, the debate over mandates is even more urgent. One particularly striking real-life example of this urgency is recent COVID-19 vaccine requirements as a condition for a life-saving organ transplant.

In October 2021, the University of Colorado Health System (UCHealth) announced that it was denying organ transplants to patients who were not vaccinated against COVID-19 in “almost all situations” because such patients had a greater likelihood of mortality. Acting on that policy, the hospital denied a Colorado woman a kidney transplant. Hospital officials told her that if she did not get the coronavirus vaccine within a thirty-day period, she would be removed from the transplant list. The decision generated a political backlash.

Other hospital systems have adopted a similar policy.

This policy has huge implications, considering the emergence of COVID-19 variants. According to the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services, there are more than 106,000 persons currently on the waiting list for an organ transplant. In 2020, however, only 39,000 persons secured a transplant, and seventeen people die each day while awaiting a transplant.

Kidney transplants, as in the Colorado case, are in the greatest demand.

Two specialists in bioethics address this question from both sides. Greg F. Burke, MD., is an internal medicine specialist, and an associate of the Geisinger Medical Center in Pennsylvania, where he serves on the hospital’s ethics committee. A graduate of Jefferson Medical College in Philadelphia, he has published numerous articles and essays on bioethics and is co-chairman of the ethics committee of the Catholic Medical Association. Emanuela Midolo, PhD, is an attorney specializing in human rights law, and a Research Fellow in Bioethics at the Italian National Center of Research. She is also a Visiting Scholar at the Kennedy Institute of Ethics at Georgetown University and was previously an adjunct professor of bioethics, history of medicine, professional ethics, and human rights at the Catholic University of the Sacred Heart in Rome.

First, we present a statement from Dr. Burke affirming the case in favor of vaccination requirements for organ transplant patients, and following it is Dr. Midolo’s rejoinder. Then we present Dr. Midolo’s statement arguing that COVID-19 vaccination should not be mandated for transplant patients, and we conclude with Dr. Burke’s rejoinder.

Read the full debate here.