A Maryland man with a criminal history and a Massachusetts father with another baby on the way both needed new hearts. Only one got the lifesaving transplant. His identity may surprise you.

The Maryland man, David Bennett Sr., got the surgery he needed, although the heart beating in his chest now came from a genetically modified pig, not another human being.

The Massachusetts man, D.J. Ferguson, is in the late stages of heart failure and has been denied a spot on the waiting list for a transplant because he has not been vaccinated against COVID-19.

Both cases have generated outrage. Days after Bennett’s surgery made headlines worldwide, The Washington Post reported that he had gone to prison decades earlier for stabbing a man, leaving him paralyzed. Although Bennett, too, was deemed ineligible to be on transplant waitlist, some people questioned whether he should have been given the pig’s heart, given his past and the fact that he has reportedly failed to make court-ordered restitution to the victim’s family.

A month after the experimental surgery, he is still doing well.

Meanwhile, Ferguson, who is 31, is being kept alive with a heart pump, according to his family. A crowdfunding site raising money to help the family says that Ferguson chose not to be vaccinated because he feared the vaccine would kill him, given his condition.

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While there have been reports of heart problems stemming from COVID-19 vaccines, medical authorities say the incidence is extremely rare. As such, some people have pointed out that even if Ferguson fears that effects of the vaccine will kill him, his odds are still better than remaining unvaccinated and not getting a heart transplant. One person donated to the GoFundMe account simply so she was able to post on the page, saying, “My 82 y/o mother has Afib and has both her vaccines and a booster. This is total (expletive) and he should not be given a new heart. Let the people who have adhered to guidelines receive this precious gift.”

But Ferguson’s family pushed back at critics, saying, “Unless you’ve been in this exact situation, your opinions are irrelevant. Please have some respect for my family. Sixty days ago we were under the impression that DJ had pneumonia, and now he’s desperately in need of a heart transplant. We are devastated. We can’t even process this.”

Bennett’s case is an anomaly. His surgeons have not said whether they knew about his criminal past, saying in a statement, “This patient came to us in dire need, and a decision was made about his transplant eligibility based solely on his medical records.”

Ferguson’s case, however, is playing out across the country, as others are also being denied a place on transplant waiting lists because of their vaccination status, including a North Carolina man and a Colorado woman who need new kidneys and an Ohio woman who needs a liver transplant.

Hospitals point out that it is standard practice for patients to be thoroughly vetted on a wide range of questions before they are deemed eligible to be on the list.

People can be turned away for a variety of reasons that might not seem fair: obesity, for example, or untreated alcohol or drug addiction. They can even turned away for not having adequate support to help during their recovery.

The hospital that was treating Ferguson, Brigham and Women’s in Boston, said it requires not just vaccination for COVID-19, but also flu and hepatitis B.

These standards exist because there are more people who need organ transplants than there are available organs. To narrow the pool, medical professional have to predict which candidates have the best chances of surviving long term. This requires a detachment that may seem cold, even heartless, to individuals and families involved, and few turned away will agree with the decision.

With hospitals defending their transplant policies regarding COVID-19 vaccination, there is little for people needing a transplant to do other than to get vaccinated. It may not always be a requirement — Matthew Wynia, director of the Center for Bioethics and Humanities at the University of Colorado’s Anschutz Medical Campus, told the Denver Gazette that COVID-19 vaccination is a “very active topic of conversation” among ethicists.

But it looks to be a requirement for at least the near future. The promise of plentiful animal organs for transplant comes with its own set of ethical problems and is still years, if not decades, away. While Bennett has survived a month, hospital officials are still speaking cautiously about his condition.

“Mr. Bennett’s evaluation continues,” a spokesman said Thursday in an email. “We have not seen evidence of rejection at this time. He is breathing on his own and was taken completely off (a respiratory machine) on January 11. His heart is fully functional. He is awake and talking and has begun physical therapy. As with any transplant, we are continuing to monitor him for complications.”

Regarding Bennett’s background, the medical center released a statement that read in part: “It is the solemn obligation of any hospital or healthcare organization to provide lifesaving care to every patient who comes through their doors based on their medical needs, not their background or life circumstances. Any other standard of care would set a dangerous precedent and would violate the ethical and moral values that underpin the obligation physicians and caregivers have to all patients in their care.”

On the other side of the country, Ferguson’s family might wish that their hospital said the same, although rejection of the COVID-19 vaccine might not be considered a “life circumstance.”

Bennett, by the way, has been fully vaccinated and boosted.