Health systems in Colorado and Washington are removing unvaccinated patients from organ transplant lists, given research that unprotected recipients are much more likely to die from Covid-19.
UCHealth in Colorado told a patient on the kidney transplant waiting list that she needed to get vaccinated in the next 30 days or she would be removed from the list. Leilani Lutali told 9News that she was the patient in question, and she hasn’t been vaccinated yet because of her religious views.
State representative Tim Geitner, a Republican, tweeted the letter she received on Tuesday and said the health system “denies life saving treatment.”
It is standard practice to require vaccinations before transplants, experts say, because anti-rejection medications make recipients immune-suppressed and puts them at extremely high risk of dying from infections, including the coronavirus.
UW Medicine also added Covid vaccination as a condition for the transplant list a few weeks ago, joining other vaccinations required for years. If patients choose not to be vaccinated, they are removed from the waiting list. In an informal Twitter poll from one transplant director, one-third of respondents said their transplant centers had similar policies.
“Transplant patients are much more vulnerable to infection,” Dr Camille Kotton, clinical director of transplant and immunocompromised host infectious diseases at the Massachusetts General hospital, told the Guardian in an email, “and transplant patients are among the higher risk for developing severe life-threatening Covid-19.”
Transplant recipients who become sick with the coronavirus have a 20 to 30% fatality rate – a shockingly higher figure than the rest of the population, at about 1.6%.
A study from July found that organ transplant recipients who are vaccinated before they received a solid organ transplant were nearly 80% less likely to be infected with Covid, compared with those who weren’t fully vaccinated.
Vaccinating patients before the procedure makes it safer for them and others around them in the hospital during and after the transplant, Kotton said. And vaccines work much better before the transplant, because patients are able to mount a strong immune response before they begin taking immune-suppressing medications.
Vaccinated patients may also be considered for organs from Covid-positive donors, a new move in the field of transplantation.
Even fully vaccinated recipients are at high risk of developing Covid-19. Transplant patients are 82 times more likely to develop breakthrough infections, and those infections are 485 times more likely to result in hospitalization or death, compared with other vaccinated people, Dr Dorry Segev, a transplant surgeon and professor of epidemiology at Johns Hopkins, told the Guardian.
“If you’re a transplant patient, you very well might get very sick, and you have a 10% chance of dying from said breakthrough infection,” he said.
Vaccination is just one way to ensure transplant patients will recover successfully, he said.
“There is a precedent for all sorts of requirements for transplant patients to go through before they are considered eligible, before they can get listed,” Segev said. That includes vaccinating for diseases like measles, mumps and rubella, pneumococcus, meningococcus and influenza – as well as examining cardiovascular health, quitting smoking or drinking, and more.
Doctors also evaluate whether a patient is “too risky to be transplanted,” Segev said. “If we think that they have too high a chance of dying if they get transplanted, then they are not a good candidate for this resource, which is a scarce resource and has to be shared across all patients across the country.”
There are more than 100,000 people on organ donation waiting lists in the US, but only 39,000 transplants occur each year.
“Physicians must consider the short- and long-term health risks for patients as they consider whether to recommend an organ transplant,” said Dan Weaver, a spokesperson for UCHealth.
Providers who require vaccination are not making a value judgment, Segev said. “They are seeing that we are still in a very aggressive fourth wave of Covid in this country. And nobody wants to transplant somebody and then have them die a month later because they got Covid and they’re highly immunosuppressed.”