Table 2: Levels of risk associated with vaccine refusal in solid organ transplantation.

Table 2 categorizes the risks considered in the utilitarian justification of denial of solid organ transplantation on the basis of vaccine refusal. The graft is placed at the broader community end of the spectrum because the placement of the organ and subsequent fate of the graft represent the summative impact of listing and allocation decisions and holds significance for all patients awaiting transplantation, not just one hypothetical recipient.

	Recipient	Increased risk of vaccine-preventable illness and sequelae Delayed diagnosis due to atypical presentations and broad differential Risk of non-adherence to other therapies and sequelae
	Other patients	Risk of transmission to solid-organ transplant patients in the clinic or transplant unit Risk of transmission events to other vulnerable patients outside of transplantation
	Institutional environment	Risk of transmission to hospital staff High cost and limited availability of post-exposure treatments
	Transplant center	Risk of legal liability related to individual outcomes, transmissions, or exposures Risk of temporary shut-downs related to infectious disease outbreaks
	Graft	Risk of graft failure or dysfunction from vaccine-preventable illness Risk of graft failure or dysfunction from non-adherence to other therapies Missed opportunity to allocate to another recipient with potentially better risk profile