Organ centers all over the U.S. are waking up to a difficult dilemma. Some transplant organizations say they won’t supply organs to patients that haven’t received the COVID-19 vaccine.
One woman with late-stage kidney disease in Colorado was recently denied a transplant after refusing to get the shot due to religious concerns. Now she’s going to Texas, where they don’t require vaccines for transplant patients, in hopes of getting a new kidney.
Critics say these policies could put transplant patients at risk, while proponents argue it’s only a matter of time before every transplant center mandates the vaccine.
Should Clinics Give Transplants to the Unvaccinated?
The debate is over whether unvaccinated transplant patients are putting themselves at risk of serious illness and death if they contract COVID-19 going forward. If that’s true, they could be squandering valuable resources that could save others.
There are around 107,000 candidates currently waiting for transplants in the U.S. Dozens of people die everyday waiting for a new organ.
This dilemma was particularly painful for Leilani Lutali, 56, of Colorado Springs, CO, who is looking for a new kidney. She says that UCHealth in Denver told her on Sept 28 that if she didn’t get the COVID-19 vaccine within 30 days, she would lose her spot on the transplant waiting list.
Both she and the donor, Jaimee Fougner, 45, of Peyton, Colorado, refused to get vaccinated, citing religious objections and uncertainty about the safety and effectiveness of the vaccines.
“I have too many questions that remain unanswered at this point. I feel like I’m being coerced into not being able to wait and see and that I have to take the shot if I want this lifesaving transplant,” Lutali said.
She said she offered to take a COVID-19 test beforehand and sign a waiver absolving the hospital of any legal liability if anything went wrong, but the facility still refused.
“At what point do you no longer become a partner in your own care regardless of your own concerns?” Lutali said.
Now she’s headed to several hospitals in Texas that don’t require the vaccine for transplant patients, including Houston Methodist and Baylor University Medical Center in Dallas.
Transplants “In Flux”
The decision to mandate the shot for transplant patients can be tricky.
A poll from the spring showed that less than 7% of transplant programs nationwide reported having inactivated patients who were unvaccinated or were partly vaccinated against the virus. But the situation continues to evolve as transplant centers weigh their options.
UCHealth in Denver says it started requiring the vaccine for transplant patients in late August, citing the American Society of Transplantation’s recommendation that “all solid organ transplant recipients should be vaccinated against SARS-CoV-2.”
The facility says the policy is designed to protect vulnerable transplant patients whose immune systems are artificially suppressed to prevent the body from rejecting the new organ.
According to Dan Weaver, a spokesperson for UCHealth, unvaccinated transplant patients face “extreme risk” of severe illness if they get infected with COVID-19, with mortality rates estimated at 20% to 30%.
Research also shows that if transplant patients get vaccinated after they get a new organ, they may fail to generate enough antibodies to protect them from severe illness.
Experts say requiring the vaccine for transplant patients is akin to asking smokers to quit six months before getting a new pair of lungs or addicts to stop drinking and using drugs before they receive a new liver.
“It is a matter of active debate. It’s really an individual program decision. In many programs, it’s in flux,” said Dr. Deepali Kumar, an expert in transplant infectious diseases at the University of Toronto and president-elect of the American Society of Transplantation.
UW Medicine in Seattle was one of the first transplant programs in the U.S. to mandate the shot. Dr. Ajit Limaye, director of the solid organ transplant infectious diseases program, says patients are already expected to meet strict criteria before receiving a transplant.
“For anyone who does not have a medical contraindication, basically we’re requiring it,” Limaye said. “There’s a very strong sense to make it a requirement, like all the other hoops, straight up.”
Meanwhile, facilities like Northwestern Medicine in Chicago continue to recommend the shot to transplant patients without issuing a mandate.
“We don’t decline care of transplant based on vaccine status,” said Jenny Nowatzke, Northwestern’s manager of national media relations. “The patient also doesn’t get any lower scores.”
Dr. Kapilkumar Patel, director of the lung transplant program at Tampa General Hospital in Florida, says this approach sends mixed messages to transplant patients.
“We mandate hepatitis and influenza vaccines, and nobody has an issue with that,” he said. “And now we have this one vaccination that can save lives and make an impact on the post-transplant recovery phase. And we have this huge uproar from the public.”
Dr. David Weill, former director of Stanford University Medical Center’s lung and heart-lung transplant program, who now works as a consultant, says the decision can be a complicated needle to thread. Handing out life-saving organs comes with a lot of responsibility.
“We really make all kinds of selective value judgments,” he said. “When we’re selecting in the committee room, I hear the most subjective, value-based judgments about people’s lives. This is just another thing.”
Weill says that unvaccinated transplant patients are typically younger and healthier except for the damage due to COVID-19, which can easily move them to the top of the transplant waiting list.
“The sick Covid patient might go ahead of the stable cystic fibrosis patient,” Weill said.
Considering the risks of severe disease, Patel says it’s only a matter of time before these mandates become the norm for transplant patients.
“I think it’s going to spread like wildfire across the country,” he said. “If you start losing patients in a year due to Covid, it will be mandated sooner rather than later.”