About 10% of all American lung transplants are given to patients suffering from COVID-19, according to a report from the United Network for Organ Sharing (UNOS), and the number is high enough to raise ethical questions about whether those who chose not to get vaccinated should be eligible for such a scarce commodity.
“They are accumulating on a steady basis. So it's very much a real thing,” UNOS chief medical officer David Klassen told NPR. “If there were more lungs available for transplants, I believe the numbers would be greater than they are.”
Since tracking began on COVID lung transplants in August 2020, 238 COVID patients have received a new lung, and the numbers are rising.
COVID patient lung transplants climbed tenfold over the pandemic’s first year. The numbers also show lung transplants due to other diseases like emphysema, cystic fibrosis or pulmonary fibrosis are down from previous years.
The rise in lung transplants among COVID patients is putting ethical pressure on the system that determines who receives a transplant, with obviously limited organs available and vaccinations against COVID now available to anyone without a medical prohibition.
“When somebody contracts such severe COVID that they need a lung transplant, and they got it refusing to get a vaccine, it's a really ethical dilemma,” David Mulligan, chair of the Yale-New Haven Health Transplantation Center, told NPR. "How can they just jump in and take a lung away from somebody who's sick, but has been doing the best they can to take care of themselves and avoid getting COVID?”
And while past behavior often doesn’t factor into who receives a transplant, future behavior can, according to Olivia Kates, assistant professor of medicine at Johns Hopkins University.
Kates told NPR that smokers who receive a lung transplant are expected to stay smoke-free after their operation.
“I think [COVID-19 patients] should be subject to the same expectation, 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,” Kates told NPR.