Lara A. Danziger‐Isakov

Background COVID‐19 vaccine is recommended for individuals ages ≥6 months; however, whether vaccination should be mandated for transplant candidates and living donors remains controversial. This study assessed COVID‐19 policies at US pediatric solid organ transplant centers. Methods A 79‐item survey was emailed between March and April 2022 to 200 UNOS Medical Directors detailing center COVID‐19 vaccine policies for transplant candidates and living donors and use of grafts from COVID‐19‐positive deceased donors. Results The response rate was 77% (154/200). For children aged 5–15 years, 23% (35/154 centers) have a COVID‐19 vaccine mandate, 27% (42/154) anticipate implementing a future mandate, and 47% (72/154) have not considered or do not anticipate implementing a mandate. For children ≥16 years, 32% (50/154 centers) have a COVID‐19 vaccine mandate, 25% (39/154) anticipate implementing a future mandate, and 40% (62/154) have not considered or do not anticipate implementing a mandate. The top two reasons for not implementing a COVID‐19 vaccine mandate were concerns about penalizing a child for their parent's decision and worsening inequities in transplant. Of 85 kidney and liver living donor centers, 32% (27/85) require vaccination of donors. Twenty percent (31/154) of centers accept organs from COVID‐19‐positive deceased donors. Conclusions There is great variation among pediatric SOT centers in both the implementation and details of COVID‐19 vaccine mandates for candidates and living donors. To guide more uniform policies, further data are needed on COVID‐19 disease, vaccine efficacy, and use of grafts from donors positive for COVID‐19 in the pediatric transplant population.