Hematopoietic stem cell transplantation (HSCT) has become a routine part of cancer care for many patients with hematologic malignancy, offering in most cases the only chance for a cure. Recent advances in transplant technology, donor databases and chemotherapy regimens have now made HSCT accessible to nearly all patients who would benefit, significantly increasing the overall demand for HSCT. Transplant centers have both clinical and psychosocial selection criteria to determine the eligibility of patients for transplant. Patients who are particularly psychosocially vulnerable are often deemed ineligible for transplant, significantly limiting their therapeutic options. This paper will explore the ethical justification for this discrimination. The primary thrust of the argument for excluding these patients is that HSCT exposes this vulnerable population to a high risk for complications, poor outcomes, and undue financial and emotional stress. They are at higher risk of developing depression, anxiety, and PTSD. Further, due to underlying issues with noncompliance these patients may be at higher risk of developing acute complications and potentially death. I will argue however, that these reasons alone may not be sufficient to justify the practice of excluding these patients from HSCT and there is potential that the current practice may represent indefensible discrimination. I will show that there is clinical equipoise regarding outcomes in this population. Clinical data favors the conclusion that psychosocially vulnerable patients have worse outcomes than less vulnerable patients. However, there is a paucity of data showing that psychosocially vulnerable patients do worse with HSCT than without, which is what would be required to justify excluding them from transplant. The goal is to foster a discussion of the ethical issues surrounding psychosocial selection criteria in HSCT and to advocate for further research into outcomes in this patient population.