CLEVELAND — It's a controversial policy that the Cleveland Clinic implemented at the peak of the pandemic: Mandatory COVID-19 vaccines for transplant donors and recipients.
For some, the decision isn't easy. That's especially true for a Wadsworth father and his young son, who the family says the clinic refuses to bend, sparking a larger ethical debate.
From the outside looking in, the Donaldson family is much like any other, but behind the curtain is a medical marathon that hit a wall of change.
"'You're having a boy; he's got kidney problems,'" Dane Donaldson remembers doctors telling him. "'He will battle this for his entire life, so you need to be prepared for it.'"
The Donaldsons' youngest son, 9-year-old Tanner, has a rare kidney disease that affects his posterior urethral valves, meaning a kidney transplant is inevitable.
"Since 2016, I've been preparing for the moment," Dane said. "To get here."
Tanner's parents were both approved as matches and decided Dane would be the donor when time came. For years, Donaldson says he stayed active, underwent routine tests, and remained at the ready for the transplant.
That was until October, when the Cleveland Clinic — whose doctors the Donaldsons have used since Tanner was born — required all transplant donors and recipients to be vaccinated against the coronavirus.
The Clinic's donor policy only applies to donors and recipients above the age of 16.
Citing their religious beliefs, along with the lack of long-term studies on the vaccine's impact, and the vaccine's limitations in stopping infections, the family requested a waiver. The Clinic said no.
"They have not given us a single option," Dane told 3News Investigates' Marissa Saenz. "It was the vaccine or you're off."
The Clinic declined to do an interview to discuss the policy and instead released a statement, telling us:
"Living donation for organ transplantation has been a life-saving treatment, but it is not without risks to the donor. For the living donor, reducing the risk of a COVID-19 infection around the time of their surgery and recovery is crucial. Individuals who are actively infected with COVID-19 have a much higher rate of complications during and after surgery, even if the infection is asymptomatic. We continually strive to minimize risk to our living donors, and vaccination is an important component to ensure the safest approach and optimal outcomes for donors.
"For the transplant candidate, in addition to a major operation, medications taken after an organ transplant weaken a person's immune response. Serious complications of COVID-19 are most likely to develop in those individuals who have weakened immune systems, as their body has a reduced ability to fight and recover from infections. The FDA-authorized vaccines have been determined to be safe and effective and are the best way to prevent severe illness and death from COVID-19, especially when administered prior to transplantation."
Dr. Lauris Kaldjian, a medical doctor and bioethics professor at the University of Iowa, says short-term data appears to suggest a majority of transplants in unvaccinated children have been successful.
"It's interesting in the context of transplants in children," he explained. "The data I have learned are interesting, because it suggests that children who get a transplant without a vaccine still have excellent outcomes."
Cleveland Clinic is actually an anomaly. Nationally, most transplant communities don't require the vaccine, largely due to its early, emergency use rollout. The FDA has since fully approved Pfizer and Moderna's shots for adults, but not for kids under 16.
"It seems that the majority or a lot of transplant professionals actually don't think the evidence-based arguments to justify the COVID vaccine mandate are actually strong enough," Kaldjian said
A nationwide survey of 141 transplant centers found that a majority — 60% — don't require the COVID-19 vaccine.
"There's anger inside of me and a little bit of resentment," Dane Donaldson admitted, "and some fear as well."
The Cleveland Clinic has been the Donaldsons' lifeline for treating Tanner's condition, and they'd like to keep it that way.
"We're going to find another place to get it," Dane stated. "It's not what we want to do; it's probably what we have to do."
The Donaldsons said they've talked to the Clinic about a religious exemption, but have not heard back. Additionally, he says moving hospitals means that the process starts all over again, on top of other complicated logistics.
The Cleveland Clinic told 3News any exceptions for the vaccine would be medical exemptions and reviewed on a case-by-case basis by a multidisciplinary team of experts. Prior COVID-19 infections are also not acknowledged as immunity.