Some organ centers tell transplant patients to get a COVID-19 shot or move down on waitlist – Daily News
A Colorado kidney transplant candidate who was bumped to inactive status for failing to get a COVID-19 vaccine has become the most public example of an argument roiling the nation’s more than 250 organ transplant centers.
Across the country, growing numbers of transplant programs have chosen to either bar patients who refuse to take the widely available vaccines from receiving transplants, or give them lower priority on crowded waitlists. Other programs, however, say they don’t have plans for such restrictions — for now.
At issue is whether transplant patients who refuse the shots are not only putting themselves at greater risk for serious illness and death from the coronavirus, but also squandering scarce organs that could benefit others. The argument echoes the demands that smokers quit cigarettes for six months before receiving lung transplants or that addicts refrain from alcohol and drugs before receiving new livers.
“It is a matter of active debate,” said Dr. Deepali Kumar, an expert in transplant infectious diseases at the University of Toronto and president-elect of the American Society of Transplantation. “It’s really an individual program decision. In many programs, it’s in flux.”
Leilani Lutali, 56, a late-stage kidney disease patient from Colorado Springs, learned in a Sept. 28 letter from UCHealth in Denver that if she didn’t begin a COVID-19 vaccine series within 30 days, she would lose her spot on the transplant waiting list. Both she and her living donor refused to get inoculated, citing religious objections and uncertainty about the safety and effectiveness of the vaccines.
“I have too many questions that remain unanswered at this point,” Lutali said. “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.”
She said she offered to be tested for COVID-19 before the surgery or to sign a waiver absolving the hospital of legal risk.
“At what point do you no longer become a partner in your own care regardless of your own concerns?” she said.
Lutali said she now hopes to take her transplant quest to Texas, where several hospitals said they don’t require vaccinations to approve active candidates for the national waiting list.
The difference between policies between one place and another underscores a tense national divide.
As of late April, fewer than 7% of transplant programs nationwide reported inactivating patients who were unvaccinated or partially vaccinated against COVID-19, according to research by Dr. Krista Lentine, a nephrologist at the Saint Louis University School of Medicine.
But that was just a snapshot in late spring, and like all coronavirus-related practices, it’s “rapidly changing,” Lentine said.
UCHealth in Denver began requiring COVID-19 vaccinations for transplant patients in late August, citing the American Society of Transplantation’s recommendation that same month that “all solid organ transplant recipients should be vaccinated against SARS-CoV-2.”
Patients who undergo transplant surgery have their immune systems artificially suppressed during recovery, to keep their bodies from rejecting the new organ. That leaves unvaccinated transplant patients at “extreme risk” of severe illness if they are infected by the coronavirus, with mortality rates estimated at 20% to 30%, depending on the study, Dan Weaver, a spokesman for UCHealth said. For the same reason, transplant patients who receive vaccines after surgery may fail to mount a strong immune response, research shows.
UW Medicine in Seattle began mandating COVID-19 vaccines this summer, said Dr. Ajit Limaye, director of the solid organ transplant infectious diseases program, adding to already required inoculations against hepatitis B and the flu, among other illnesses.
But Northwestern Medicine in Chicago, where doctors performed the first double-lung transplant on a COVID-19 patient in June 2020, is encouraging — but not requiring — vaccination against the pandemic disease.
The lack of consistent practice across 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-19 vaccines are not required.
“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.”
Nearly 107,000 candidates are waiting for organs in the U.S.; dozens die each day still waiting.
Transplant centers evaluate which patients are allowed to be placed on the national list, taking into account medical criteria and other factors like financial means and social support to ensure that donor organs won’t fail.
“We really make all kinds of selective value judgments,” said Dr. David Weill, former director of Stanford University Medical Center’s lung and heart-lung transplant program who now works as a consultant. “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.”
The centers can choose to place candidates on inactive status for myriad reasons, including medical noncompliance, according to data from the United Network for Organ Sharing, which oversees transplants. As of Sept. 30, that category accounted for 738 of more than 47,000 registrants waiting in inactive status, though it’s not clear how many are tied to vaccine refusal.
A particularly thorny question involves unvaccinated people who need transplants specifically because COVID-19 infections destroyed their organs. As of late September, more than 200 lungs, as well as at least six hearts and two heart-lung combinations, had been transplanted for coronavirus-related reasons in the U.S., according to UNOS data.
Many of those organs were transplanted earlier in the pandemic, before any vaccine was widely available. That’s no longer the case, Weill said.