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Colorado kidney transplant candidate who was returned to inactive status for not having been vaccinated against Covid-19 has become the most public example of an argument shaking more than 250 organ transplant centers from the country.
Across the country, a growing number of transplant programs have chosen to either ban patients who refuse to take widely available Covid vaccines from receiving transplants or give them lower priority on organ waiting lists. overcrowded. Other programs, however, say they don’t provide for such restrictions – just yet.
The question is whether transplant patients who refuse injections are not only at increased risk of serious illness and death from Covid infections, but also waste rare organs that could benefit others. The argument echoes demands that smokers quit smoking for six months before receiving a lung transplant 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 within 30 days , she would lose her place on the transplant waiting list. She and her 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 releasing the hospital from legal risk for its refusal of a 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 require a Covid vaccination to approve active candidates for the D-List. national expectation.
The difference between policies in Denver and Texas – and elsewhere – points to a tense national divide. At the end of April, less than 7% of transplant programs nationwide reported having inactivated patients who were not vaccinated or were partially vaccinated against Covid, according to research by Dr Krista Lentine, nephrologist at the medical school from the University of Saint Louis.
But it was only a snapshot in late spring, and like all Covid-related practices, it is “changing rapidly,” Lentine said.
UCHealth in Denver began requiring Covid vaccinations for transplant patients in late August, citing the American Society of Transplantation recommendation in August that “all solid organ transplant recipients should be vaccinated against SARS-CoV- 2 ”, the official name of the coronavirus which causes Covid -19.
The immune system of transplant patients is artificially suppressed during recovery, to prevent their bodies from rejecting new organs. This puts unvaccinated transplant patients at “extreme risk” of serious illness if infected with the coronavirus, with death rates estimated at 20% to 30%, according to the study, said Dan Weaver, spokesperson. word of UCHealth. For the same reason, transplant patients who receive Covid vaccines after surgery may not develop strong immune responses, research shows.
We are making hepatitis and flu shots mandatory, and no one has a problem with that.
UW Medicine in Seattle began making Covid vaccinations mandatory this summer, said Dr Ajit Limaye, director of the solid organ transplant program for infectious diseases. 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 it 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 Covid-19.
“We do not refuse transplant care based on immunization status,” said Jenny Nowatzke, director of national media relations for Northwestern. “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 vaccinations 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.”
Nearly 107,000 applicants await organs in the United States; dozens die every day while waiting. Transplant centers assess which patients are allowed to be on the national list, taking into account medical criteria and other factors, such as financial means and social support to ensure that donor organs do not fail. .
“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, or UNOS, 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 inactive statuses are linked to vaccination status.
A particularly thorny issue concerns unvaccinated people who need transplants precisely because Covid infections have destroyed their organs. By the end of last month, more than 200 lungs, along with at least six hearts and two heart-lung combinations, had been transplanted for Covid-related reasons in the United States, according to UNOS data.
Many organs were transplanted earlier in the pandemic, before a Covid vaccine was 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’re making a sort of statement.”
These patients are generally younger and healthier than other transplant candidates, aside from Covid-related damage, and they are often critically ill enough to be at the top of any transplant list. “The patient with Covid could walk past the stable patient with cystic fibrosis,” Weill said.
Patel of Tampa General said he performed a lung transplant on a patient who was transferred to Florida after being struck off from 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.
Patel said he thanked that eventually almost all transplant programs will make vaccination against Covid mandatory, 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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The ratios deviate significantly from the actual racial and ethnic distribution of the United States
“It is clear that this pandemic has hit every community in America,” Besser said, “but it has not hit all communities with the same ferocity.”
Census data shows that about 60 percent of the U.S. population is white, and about 40 percent identify with racial or ethnic minority groups.
In contrast, 65% of children who have lost their parents to Covid-19 belong to racial and ethnic minority groups, compared to 35% white, Hillis said.
“It truly is one of the most extreme disparities I have ever seen,” she said.
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