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A Massachusetts man may be choosing death over a life-saving transplant, because he refuses to get vaccinated against COVID-19.

As CBS Boston reports, 31-year-old DJ Ferguson, a patient who was previously at the top of the heart transplant list at Boston's Brigham and Women's Hospital, has been removed from the donor recipient list because his refusal to get the jab makes him a poor candidate for the risky surgery.

Before the COVID-19 pandemic, hospitals denied transplants to needy patients all the time for "lifestyle choices" like smoking, alcoholism, and sometimes even obesity — because there are far fewer donor organs than there are patients who need them, leaving hospitals with the gut-wrenching choice of deciding who lives and who dies.

These circumstances were and remain tragic — it is a matter of life and death, after all.

But in the middle of a pandemic, hospitals have had to add an additional criterion to their decision-making: whether a transplant candidate is likely to survive potential COVID infection once their immune system is decimated following the operation.

"Post any transplant, kidney, heart whatever, your immune system is shut off," Arthur Caplan, the head of medical ethics at NYU Grossman School of Medicine, told CBS. "The flu could kill you, a cold could kill you, COVID could kill you."

Ferguson's family, of course, doesn't see it that way.

"My son has gone to the edge of death to stick to his guns and he’s been pushed to the limit," David Ferguson, the patient's father, told CBS. "It’s kind of against his basic principles; he doesn’t believe in it."

"It’s a policy they are enforcing and so because he won’t get the shot," Ferguson continued, "they took him off the list of a heart transplant."

In a statement to CBS, the hospital noted that they're not the only ones who are "enforcing" the policy.

"Like many other transplant programs in the United States," the hospital's statement read, "the COVID-19 vaccine is one of several vaccines and lifestyle behaviors required for transplant candidates in the Mass General Brigham system in order to create both the best chance for a successful operation and also the patient’s survival after transplantation."

The report quickly went international after a British tabloid picked it up, subsequently drawing online attention from anti-vaxx groups.

The case exemplifies the fraught ethics of medicine and the overwhelmingly difficult decisions American hospitals have to face, and which have only been exacerbated by the pandemic.

The Fergusons have made their choice and have staked their principles potentially over their son's life — but it's also up to the hospitals to ensure organs have the best rate of success in order to save lives, especially given the extremely tight supply.

READ MORE: Hospital refusing heart transplant for man who won't get vaccinated [CBS News]

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