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Colorado and Washington health systems 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 must be vaccinated within the next 30 days or she will be removed from the list. Leilani Lutali told 9News that she was the patient in question and had not yet been vaccinated due to her religious views.
State Representative Tim Geitner, a Republican, tweeted the letter she received on Tuesday and said the health system “is refusing life-saving treatment.”
It is common practice, experts say, to require vaccinations before transplants because anti-rejection drugs weaken the immune system of recipients and put them at extremely high risk of dying from infections, including the coronavirus.
UW Medicine also added the Covid vaccination as a condition to the transplant list a few weeks ago, joining other vaccinations that have been required for years. If patients choose not to be vaccinated, they are taken off the waiting list. In a informal Twitter poll from a transplant manager, 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 Massachusetts General Hospital, told The Guardian in an email, “and transplant patients are among the most at risk of developing a serious life threatening Covid-19.
Transplant recipients who become ill with the coronavirus have a death rate of 20-30% – a figure shockingly higher than the rest of the population, at around 1.6%.
A July study found that organ transplant recipients who are vaccinated before receiving a solid organ transplant were almost 80% less likely to be infected with Covid, compared to those who were not fully vaccinated.
Vaccinating patients before the procedure makes life 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 build a strong immune response before they start taking immunosuppressive drugs.
Vaccinated patients can also be considered for organs from donors positive for Covid, a new breakthrough 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 these infections are 485 times more likely to result in hospitalization or death, compared to other vaccinated people, said Dr Dorry Segev, transplant surgeon and professor of epidemiology at Johns Hopkins. Guardian.
“If you are a transplant patient, you could very well get very sick and you have a 10% chance of dying from this breakthrough infection,” he said.
Vaccination is only one way to ensure that transplant patients will recover successfully, he said.
“There is precedent for all kinds of requirements for transplant patients before they are considered eligible, before they can be listed,” Segev said. This includes vaccination against diseases like measles, mumps and rubella, pneumococcus, meningococcus, and influenza, as well as examining heart health, stopping smoking or alcohol, and more. .
Doctors also assess whether a patient is “too risky to be transplanted,” Segev said. “If we think they are too likely to die if they are transplanted, then they are not a good candidate for this resource, which is a scarce resource and must be shared among all patients across the country.”
There are over 100,000 people on waiting lists for organ donation in the United States, but only 39,000 transplants take place each year.
“Physicians should consider the short and long-term health risks of patients when considering recommending an organ transplant,” said Dan Weaver, spokesperson for UCHealth.
Providers who require vaccination do not make value judgments, Segev said. “They see that we are still in a very aggressive fourth wave of Covid in this country. And no one wants to transplant someone and have them die a month later because they caught Covid and are highly immunocompromised. “
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