Canadian Transplant Candidates’ and Recipients’ Perspectives on Mandatory Vaccination and Access to Transplantation: A Qualitative Study

BACKGROUND: Given the stronger immunological effects of vaccines pre-transplant, the question of whether pre-transplant COVID-19 vaccination should be mandatory has been raised. The objective of this study was to gather transplant patients' perspectives on ethical issues related to mandatory vaccination and access to transplantation in Canada. METHODS: We conducted semi-structured interviews with 45 transplant recipients and five transplant candidates from a Québec transplant program. The interviews were digitally recorded and transcribed. Thematic and content analysis was conducted. RESULTS: Most participants were in favor of pre-transplant vaccine mandates given that vaccination is part of pre-transplant assessment, transplant patients have moral responsibilities and/or vaccine mandates are legitimate especially in a public health emergency. Restrictions on patient autonomy, the ethical duty to ensure access to life-saving transplantation and unequal access to vaccines were concerns raised by participants about vaccination mandates and access to transplantation. Many participants did not support excluding unvaccinated patients from transplant lists. Most, however, agreed with prioritizing vaccinated candidates in organ allocation. CONCLUSION: This study indicates broad support for the promotion of pre-transplant vaccination. However, preventing access to life-saving organ because an individual is missing specific vaccinations raised concerns among participants. The results of this study could inform vaccination policies in transplantation in future public health emergencies.