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Across the country, a growing number of transplant programs have chosen to either ban patients who refuse to receive widely available covid vaccines from receiving transplants or give them lower priority on waiting lists. overcrowded bodies. Other programs, however, say they don’t provide for such restrictions – just yet.
The question is whether transplant patients who refuse injections not only put themselves at an increased risk of serious illness and death from Covid infection, but also waste rare organs that could benefit others. The argument echoes demands that smokers quit smoking for six months before receiving lung transplants or that addicts refrain from consuming alcohol and drugs before receiving a new liver.
“This is a matter of active debate,” said Dr. Deepali Kumar, expert in infectious diseases of transplantation at the University of Toronto and president-elect of the American Society of Transplantation. “It’s really an individual program decision. In a lot of programs, it’s in motion.”
Leilani Lutali, 56, a patient with advanced kidney disease from Colorado Springs, Colo., Learned in a September 28 letter from UCHealth in Denver that if she did not start a series of covid vaccines in the 30 days, she would lose her place on the transplant waiting list. She and her living donor, Jaimee Fougner, 45, of Peyton, Colorado, refused to be vaccinated, citing religious objections and uncertainties about the safety and effectiveness of the vaccines.
“I have too many questions that remain unanswered at this stage. I feel like I am forced not to be able to wait and see and that I have to take the blow if I want this life-saving transplant,” Lutali said.
She said she had offered to get tested for covid before the operation or to sign a waiver freeing the hospital from legal risk for its refusal of the vaccine. “At what point do you no longer become a partner in your own care, regardless of your own concerns? ” she said.
Lutali now hopes to take his transplant quest to Texas, where several hospitals, including the Houston Methodist and Baylor University Medical Center in Dallas, have said they do not need a covid vaccination to approve active candidates for the. national waiting list.
But that was only a snapshot in late spring, and like all covid-related practices, it “is moving fast,” Lentine said.
UCHealth in Denver began requiring covid vaccinations for transplant patients in late August, citing the American Society of Transplantation’s August recommendation that “all solid organ transplant recipients should be vaccinated against SARS. -CoV-2 “.
UW Medicine in Seattle began mandating covid vaccines this summer, said Dr Ajit Limaye, director of the solid organ transplant infectious disease program. Patients already had to meet other strict criteria to be considered for a transplant, including receiving vaccines against several diseases, such as hepatitis B and influenza.
“For anyone who doesn’t have a medical contraindication, basically we demand it,” he said. “There is a very strong sense to make this a requirement, like all other hoops, straight ahead.”
In contrast, Northwestern Medicine in Chicago, where doctors performed the first double lung transplant on a covid patient in June 2020, encourages – but does not require – vaccination against pandemic disease.
“We don’t refuse transplant care based on immunization status,” said Jenny Nowatzke, Northwestern’s national media relations manager. “The patient also does not get lower scores.”
The lack of consistent practice between programs sends a mixed message to the public, said Dr. Kapilkumar Patel, director of the lung transplant program at Tampa General Hospital in Florida, where covid vaccines are not required.
“We are mandating the hepatitis and influenza vaccines, and no one has a problem with that,” he said. “And now we have this vaccine that can save lives and impact the post-transplant recovery phase. And we have this huge outcry from the public.”
“We really do all kinds of selective value judgments,” said Dr. David Weill, former director of the lung and heart-lung transplant program at Stanford University Medical Center, who now works as a consultant. “When we select in the committee room, I hear the most subjective and value-based judgments about people’s lives. It’s just another thing.”
Centers may choose to place applicants on inactive status for a variety of reasons, including medical non-compliance, according to data from the United Network for Organ Sharing, which oversees transplants. As of September 30, this category represented 738 of the more than 47,000 registrants awaiting inactive status, although it is not clear how many are linked to vaccination status.
A particularly thorny issue concerns unvaccinated people who need transplants specifically because covid infections have destroyed their organs. By the end of September, more than 200 lungs, along with at least six hearts and two heart-lung combinations, had been transplanted for reasons related to covid in the United States, according to UNOS data.
Many of these organs were transplanted earlier in the pandemic, before a vaccine against covid became widely available. This is no longer the case, says Weill. “If you just got the vaccine, you did it at gunpoint, actually,” he said. “It’s not just a personal choice; they are making a sort of statement.”
These patients are generally younger and healthier than other transplant candidates, aside from covid damage, and they are often sick enough to top any transplant list. “The sick covid patient could walk past the stable cystic fibrosis patient,” Weill said.
Patel of Tampa General said he performed a lung transplant on a patient who was transferred to Florida after being struck off the list at another center because he was not vaccinated against covid. “I basically mandated him on a handshake that he would get his vaccine after the transplant,” Patel said. “But his family? They do not agree.
Ultimately, Patel said, he believes almost all transplant programs will mandate covid vaccination, in large part because transplant centers are evaluated on the long-term survival of their patients.
“I think it’s going to spread like wildfire across the country,” he said. “If you start losing patients in a year from covid, it will be mandatory as soon as possible.
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